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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
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Central Adelaide Local Health Network Criteria Led Discharge and it’s place in Multidisciplinary Discharge Planning
Transcript
Page 1: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Central Adelaide

Local Health Network

Criteria Led Discharge

and it’s place in Multidisciplinary

Discharge Planning

Page 2: Sharon Berry, The Queen Elizabeth Hospital - 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

Page 3: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 4: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 5: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 6: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Development of Criteria Led

Discharge in Central Adelaide LHN

Page 7: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 8: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 9: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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.

Page 10: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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 Fellow’s 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

Page 11: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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’

Page 12: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Criteria Led Discharge in

The Queen Elizabeth Hospital

Medical Directorate

Page 13: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 14: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Ward South One Experience

Page 15: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning
Page 16: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 17: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Criteria Led Discharge in the Acute

Medical Unit at

The Queen Elizabeth Hospital

Page 18: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 19: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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)

Page 20: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 21: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 22: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Communication strategies

Page 23: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Simple Standard Operating Procedure developed

and distributed to all staff

Communication strategies

Page 24: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

CLD Format

A generic form was

developed for use

across all medical

patients (same model

that was

implemented in 2007

– adjusted to clinical

specifics)

Page 25: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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)

Page 26: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning
Page 27: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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)

Page 28: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 29: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

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

Page 30: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

New patients pulled from the emergency

department earlier and treatment regimes

beginning earlier

Medical staff ‘feel safe’ that the nursing

staff won’t discharge patients that are

outside of the established parameters

Value added to patient care

and staff morale

Page 31: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Where to from here…..

Page 32: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Sustainability

To be driven by a team of staff or system approach

- until this point all our attempts have been driven

by individuals and when they leave - the process

generally leaves too

Communication is vital in ‘selling the message’

about the benefits of CLD and it’s contribution in

addressing patient flow, capacity management,

patient satisfaction and staff workload balance

It is not only about CLD in isolation - discharge

discussions need to happen daily even if CLD is

not an option for each patient

‘Talk like a team for the discharge stream’

Page 33: Sharon Berry, The Queen Elizabeth Hospital - Criteria Led Discharge and its Place in Multidisciplinary Discharge Planning

Questions?


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