Discovering great geriatric care

Version 3 13 August 2014

Tom DownesConsultant GeriatricianClinical Lead for Quality Improvement, Sheffield Teaching HospitalsThe Health Foundation / IHI Quality Improvement Fellow28th September 2016

GREAT CARE IS DISCOVERED, NOT DECIDED

Steve Spear, MIT

Sheffield:• Population of 580k and

growing• Europe’s greenest city• 43% of households

vulnerable to significant financial stress

• Single vertically integrated adult provider

• Single Social Care provider• Single Care Commissioning

Group

Sheffield Teaching Hospitals:• One of largest FTs in

England - £1bn turnover and 16k staff

• Large tertiary provider – around one-third of activity

Funding constraints:

George

A complex system problem

2003 Toyota Corolla

The Big Room (Oobeya)

The Big Room in Action

Physiotherapist gives an account of the test of change to get a patient home on the day theywere discharged by the GSM consultant

Senior registrar

General ManagerFor Medicine

GSMMatron

ServiceImprovement

Social ServicesManager

CommunityServicesmanagerPhysiotherapist

Secretary

DischargeLiaison

Let me introduce ‘George’

•82 years old•Lives independently and wants to continue doing so•Widowed 5 years ago•Has mild dementia•Daughter lives locally•Losing weight + poor mobility

PDSA tests of moving from ‘post take’ to ‘on take’

Frailty Unit

Outcome measure: 34% increase in discharge within 1 day

Frailty Unit

opens

Length of stay for frailty unit patients reduced by more than 4

days

Frailty Unit

opens

In-hospital mortality dropped by over 13%

Frailty Unit

opens

Discharge to Assess (D2A)

D2A starts

Reduction of 6 days waiting on

implementing D2A

D2A starts

Sustained 30% reduction of LoS

D2A starts

30% reduction of inpatient falls on pilot

ward

In last one year >10,000 patients discharged to

home support in 1.2 days compared with 5.5 days

Whole system reduction in LoS of patients aged >65y

“It’s changed the way we think.”

Future

• Frailty Unit is continuing to discover improved process and hitting highest ever discharge rate

• Purpose designed Frailty Unit opens 2017 to enhance efficiency and care experience

• Big Room is currently testing D2A for more complex patients

How do we get better at making patients better?

Discovery.

@sheffielddoc

Thank youTom.Downes@sth.nhs.uk

Version 3 13 August 2014