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Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in...

Date post:22-Aug-2014
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Sharon Berry, Clinical Services Coordinator - Acute Medicine & Acute Medical Unit, Central Adelaide Local Health Network, The Queen Elizabeth Hospital delivered the presentation at the 2014 Discharge Planning Conference. The 2014 Discharge Planning Conference - Assisting health services to adopt an integrated and consumer directed approach to discharge planning. For more information about the event, please visit: http://bit.ly/dischargeplan14
  • Central Adelaide Local Health Network Criteria Led Discharge and its place in Multidisciplinary Discharge Planning
  • Criteria Led Discharge (CLD) Criteria led discharge provides an option for addressing timely discharge by equipping clinicians aside from a Medical Officer with the necessary knowledge, skills and experience to review patients and initiate discharge in line with criteria, policies and procedures which have a multi-disciplinary agreement. We are CENTRAL
  • CLD ensures that a patient discharge may occur when defined criteria are met. If the patient does not meet the criteria, then the CLD process is abandoned. This means that clinical staff may discharge a patient without waiting for a routine medical review as long as certain predetermined criteria have been documented and met. We are CENTRAL
  • Benefits of CLD To actively reduce the delays experienced by patients due to difficulty obtaining individual medical decisions when being discharged from hospital To provide a model that facilitates timely discharge for patients To empower frontline clinical staff to provide timely discharge for patients and the organisation To ensure high quality and consistency of discharge management practices Improve patient flow Reduce length of stay We are CENTRAL
  • Timely communication with patients / families / carers avoiding unexpected late / unplanned discharges Timely communication between health care professionals Provide a smooth discharge process over 7 days Assist medical staff workload (and provide some structure in duties) Admit the emergency or elective patient earlier therefore beginning treatment earlier Assist meet hospital wide targets We are CENTRAL
  • Development of Criteria Led Discharge in Central Adelaide LHN
  • Background Criteria Led Discharge (Event Led Discharge) was first trialled in 2007 within units at the Royal Adelaide Hospital In 2009, SA Health released the Criteria Led Discharge policy directive Targeted projects since at both the Royal Adelaide and The Queen Elizabeth Hospital with little sustainability Differing models exist within 23 hour units across our sites We have not been able to sustain any of the models to date
  • In 2013, 6 Central Adelaide clinicians participated and graduated with Joanna Briggs Institute (JBI) Fellowship specifically designed for research and implementation of CLD Central Adelaide have developed a toolkit for staff to utilise when developing and implementing a CLD Central Adelaide have aligned their procedural guidelines to the SA Health directive
  • Joanna Briggs Institute Is the international not for profit research and development arm of the School of Translational Science based within the Faculty of Health Sciences at the University of Adelaide. It aims to provide the best available evidence to inform clinical decision making at the point of care.
  • JBI Clinical Fellowship Program Significant investment of clinician time: 22 weeks in total Stage 1- intensive week long training residency The conduct of a clinical audit in the Fellows own practice site Stage 2 further week long intensive training residency JBI staff remained in contact throughout Presentation and graduation of findings of Clinical Fellows CLD projects
  • Barriers we need to overcome Incentive and buy in for staff to implement How do we measure the impact Streamlining the discharge communication, practice and process Consideration with EPAS roll out Confidence of nursing staff to lead Target the right patient group / pathway Developing a consistent process as part of orientation and the communication strategy Having the model as a opt out not opt in
  • Criteria Led Discharge in The Queen Elizabeth Hospital Medical Directorate
  • Aim For discharge planning to commence on admission by a multi-disciplinary team That discharge should be non complex That discharge practices should align with best patient care To identify and effect change across discharge practices To improve capacity management and capability within the hospitals through reducing length of stay and improved use of resources To collaborate and improve relationships with a medical team that is supportive of CLD
  • Ward South One Experience
  • Progress Ward South One Intermittent use of CLD by General Medicine team Plans to explore making CLD an opt out model for all discharges Progress has slowed due to the lead of the CLD project for the Medical Directorate leaving TQEH The model has been discussed in other units for implementation e.g. cardiology, endocrine and gastroenterology teams
  • Criteria Led Discharge in the Acute Medical Unit at The Queen Elizabeth Hospital
  • CLD application in the AMU AMU was invited to participate in a Clinical Redesign project using Lean Thinking principles AMU mapped current processes and confirmed that the patient exit from the hospital continues to be a barrier to meeting admission targets AMU and the Medical Directorate decided to target the communication and discharge practices during the patient journey which included implementation of CLD
  • Background Current discharge practices were not timely or in line with the SA Health suggested AMU Model Of Care i.e. 48hrs (TQEH AMU was developed with a 72hr LOS target before the guidelines were developed) Inconsistent communication by Multi-D team Increased LOS for the non-AMU patient outlied in AMU Pt not receiving R) care at R) time in R) place Multiple outliers i.e. at times 3 AMU patients in AMU and 15 AMU in outlied wards as AMU has other clinical units patients No Criteria Led Discharge (CLD)
  • Getting the message across We were not re-inventing the wheel (utilising the General Medicine CLD) CLD is not a new strategy We have strong support from our Consultant underpinning the success of the implementation of CLD on the AMU Education sessions provided to all AMU medical officers, nursing staff and allied health staff prior to implementation Close monitoring is on-going
  • Counter Measure Activities to support CLD To support interdisciplinary communication regarding CLD we developed a discharge huddle at our patient journey board each day at 3pm with the senior nurse for the afternoon shift, the RMO, Pharmacist and ward clerk
  • Communication strategies
  • Simple Standard Operating Procedure developed and distributed to all staff Communication strategies
  • CLD Format A generic form was developed for use across all medical patients (same model that was implemented in 2007 adjusted to clinical specifics)
  • Early results Average discharge time decreased slightly since huddles and other discharge strategies implemented i.e. average time previous was 1416hrs (variable) but since huddle consistently going down (taken about 30 mins off discharge time)
  • Comparison of discharge 11 targets July 2013 to December 2013 25 AMU patients discharged by 11am January 2014 to June 2014 53 patients discharged by 11am (Clinical Redesign strategies implemented which included CLD)
  • Early success Discharge medications / scripts done day before discharge Transport organised earlier Discharge process more organised and coordinated Huddle letter done on OACIS day prior to discharge (nursing and medical) Approximately 20 patients discharged via CLD over last 4 months Improved Multi-D communication Ward South1 at TQEH interested in implementing the 1500hr discharge huddle where CLD can be discussed
  • Value added to patient care and staff morale More streamlined discharge process Patients and staff communicate about discharge process earlier Less complaints from patients and families about lack of discharge communication Pharmacy education is provided the day prior to discharge Improved Multi-D approach to patient care
  • New patients pulled from the emergency department earlier and treatment regimes beginning earlier Medical staff feel safe that the nursing staff wont discharge patients that are outside of the established parameters Value added to patient care and staff morale
  • Where to from here..
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