NHS Dumfries and Galloway case study: balancing capacity with demand

Rolling Out Daily Dynamic Discharge Across the Hospital

From September to December 2016, Daily Dynamic Discharge was rolled out to most acute medical and surgical wards in the hospital. This rapid roll-out was achieved by implementing one ward each week up to the middle of December. Daily Dynamic Discharge was discussed at the Senior Charge Nurses' monthly meetings and the success of the exemplar ward was shared to build engagement and momentum.

Figure 9: Monitoring Outcomes

The roll-out programme is still underway, however the hospital has undertaken some 12 week post-Daily Dynamic Discharge outcome measurements and compared them to the same 12-week period the previous year. The results are encouraging, particularly in view of the fact that it relates to a challenging time of year.

They show more balanced discharge profiles and earlier in the day discharging across the week in all wards. Increased weekly discharges and a reduction in length of stay is also being achieved.

There was a spike in medical/ GP referrals and admissions between 1 November 2016 and 28 February 2017, compared to the previous winter period. This resulted in a 30% increase in admissions for this patient group. This was particularly challenging for Ward 12 which comprises respiratory and stroke specialties. It experienced a rise in admissions, including Respiratory Syncytial Virus ( RSV) and flu positive patients being admitted, which impacted performance.

In spite of this additional demand, overall the hospital coped well, maintaining a performance of 91.9% against the four hour target.

Project Manager, Patsy Pattie said:

"In previous winters we have regularly opened our Day Surgery unit to cope with the extra demand and to assist with patient flow. This year we didn't have to open the unit throughout the festive period, and in fact have only had to open it on a handful of occasions. Winter is always challenging and some may question if this was the right time to introduce such a bold change. I look at it from a different perspective. With such a significant rise in admissions and acuity of patients, if we had not implemented Daily Dynamic Discharge what would
have happened?"