Criteria Led Discharge Project Bradford District Foundation Care Trust What We Did & Our Lessons Learned
Bradford District Population - Deprivation The Index of Multiple Deprivation 2015 places Bradford as the 19th most deprived district nationally (where 1 is the most deprived authority and 326 is the least deprived). Of the 31 districts in the Yorkshire and Humber region, Bradford is the second most deprived behind the City of Hull.
Criteria Led Discharge BDCT Driver 1.Innovative 2.Patient Safety 3.Care Closer to home
Project Charter Project Team Stakeholders Role Name Role Name Project Sponsor Debra Gilderdale Staff engagement, Patient & Carer liaison, NHSI Project Leader Grainne Eloi Team Members Sarah Deacon Thabani Songo Mohammed Sheraz Ullslam Neil Buckingham Sarfaraz Shora Julie Megaw Karl Bexley Chris Dixon Tracy Loxam Jo Gott Mark Trewin Bernard Hughes Problem Statement Management of the admissions and discharges vary depending on core and evening and weekend cover which impacts patient flow. The discharge rates and trends aren't fully understood for different days of the week and how this impacts the average length of stay. The average length of stay during the last 6 months are 194 days on Heather & 83 days Oakburn. Goal Statement Improve average length of stay by introducing consistency of approach and revised discharge criteria. During the 90 day pilots the ambition is to decrease length of stay by 10% maximising the use and connection /better use of community & IHTT resources. The pilot of 2 wards Heather and Oakburn will undertake local detailed monitoring and track operational changes and report lessons learned over the 90 day trial prior to rolling out any success measures and learning across wider inpatients in both acute and specialist wards. Quality Issues Summary Embedding a consistent approach to discharge will aim to improve patient experience and flow of care into the community. Customers Patient, carers, ward staff, IHTT Staff, CCG, community LA, partnerships (Housing) consistency and compliance, finance and better care/supporting ambition of care closer to home.
How did we do it?
Pilot Wards - Heather Average Length of stay was a 179 days at the start of the project. It went down to 77 day by the 8 th of Oct. Which is a 57% reduction from the start of the project A total of 47 unique client went through CLD process
Pilot Ward- Oakburn Average Length of stay was a 79 days at the start of the project. It went down to 29 day by the 8 th of Oct. Which is a 63% reduction from the start of the project A total of 60 unique client went through CLD process
Deliverables Act, Plan, Study, Do Date planned completion Who Complete/In Progress Deliverable Date initiated Process Map our current agreed process and review Study 07/08/2017 15/09/2017 Heather/Oakburn Sarah &Jo Complete Mobilise Task Team DO 07/08/2017 15/08/2017 Sarah/Jo Complete Discuss project and ambition with all stakeholders including EMT and plan wider communications Review admission/discharge tracker within Plan 15/08/2017 15/09/2017 Sarah Deacon Complete 24 hours of admission with forecasted discharge date DO 15/08/2017 30/08/2017 Neil /Sarfaraz Complete Care Programme Approach plan booked and completed within 3 working days Study 15/08/2017 02/10/2017 Ward Manager/named nurse In Progress Baseline and track days of the week for dischstudy 07/08/2017 30/10/2017 Sheraz or James Complete Baseline and track average length of stay Study 07/08/2017 30/10/2017 Sheraz or James Complete Engagement sessions with Medics re ambition Act 30/08/2017 Grainne /Sarah Complete PIA Do 30/09/2017 Grainne/Jo Complete live template to track discharge Act/Plan 10/09/2017 25/09/2017 Sheraz Complete Develop step down reccomendation to facilitate difficult to discharge patients safely. Do 15/08/2017 30/09/2017 Grainne/Mark Not Started Admission & discharge process tracking and patterns/trends 24/7 Study 07/08/2017 15/08/2017 Sheraz or James Complete Dishcarge Tracker Study and Do 15/08/2017 25/09/2017 Sheraz Complete Complete deliverables 10 Total deliverable 12 Percentage complete 83%
1. Bespoke System
1. Bespoke System (Continued)
2. Live Information
2. Live Information (Continued)
AVE DAYS AVE DAYS 3. Reduced Length of Stay (LOS) 100 80 60 40 20 0 NHSE Return for LOS for Acute working age 85 52 53 50 49 35 45 28 Sep Oct Nov Dec Jan Feb Mar Apr 2017 2018 Our LOS of Acute working age - SPC including active clients 200 150 100 149 122 121 116 104 94 81 68 50 0 Sep Oct Nov Dec Jan Feb Mar Apr 2017 2018 Report Period ALOS Days Start 01/09/2017 149 End 20/04/2018 68 % Difference 54.9%