NHS Dumfries and Galloway case study: balancing capacity with demand

Key Learning Points

• Dumfries and Galloway Royal Infirmary spread the word about Daily Dynamic Discharge using posters, questionnaires, opportunistic conversations with team members and site huddles. This helped to build momentum across its wards - if Ward 10 can do it, why can't we?
• Small changes can have a big cumulative effect.
• It is important to choose the exemplar ward carefully - a highly motivated ward champion is essential.
• Each ward has its Daily Dynamic Discharge huddle at a time to suit their circumstances, which makes it easier for specialists to attend more than one daily ward huddle.
  
• A standardised approach means that, as staff rotate around wards, they encounter the same Daily Dynamic Discharge process.
• The hospital plans to include Daily Dynamic Discharge as part of the induction programme for new doctors.
• The multidisciplinary team approach is spreading the word about Daily Dynamic Discharge. It is not just management telling teams to do something. This sense of ownership among staff helps to ensure sustainability.
• Check Chase Challenge also helps sustain successful implementation.
• The hospital encourages staff to avoid inputting meaningless Estimated Date of Discharge (EDDs). However, if there is no EDD, staff need to be clear that the patient is still under investigation and that an accurate EDD will be decided soon (this should be within first 24 hours).
• It is important for staff to recognise the impact of delayed discharges and admissions on other professions/services, such as pharmacy.

Deliver: safe, person-centred, effective care to every patient, every time, without waits, delays and duplication

In order to: improve the experience of patients and staff

The 6 Essential Actions:

Clinically Focused and Empowered Management

The operation of basic hospital and facilities management, visible leadership and ownership through managerial, nursing and medical triumvirate team, creation of clear escalation policies and improved communication supported by safety and flow huddles.

Capacity and Patient Flow Realignment

Establishing and then utilising appropriate performance management and trend data to ensure that the correct resources are applied at the right time, right place and in the right format. This will include Basic Building Blocks, Bed Management Toolkit, Workforce Capacity Toolkit and alignment with Guided Patient Flow Analysis.

Patient Rather Than Bed Management

Managing the patient journey requires a coordinated multi-disciplinary approach to care management, dynamic discharge processes: access to diagnostics, appropriate assessment, alignment of medical and therapeutic care; home when ready with appropriate medication and transport arrangements, discharge in the morning, criteria led discharge, transfers of care to GP.

Medical and Surgical Processes Arranged for Optimal Care

Designed to pull patients from ED through assessment/receiving units , provide access to assessment and clinical intervention, prompt transfer to specialist care in appropriate place designed to give care without delay, move to downstream specialty wards without delay and discharge when ready, utilising criteria-led discharge where appropriate.

7 Day Services

The priority is to reduce evening, weekday and weekend variation in access to assessment, diagnostics and support services focussed on where and when this is required to: avoid admission where possible, optimise in-patient care pathway, reduce length of stay and improve weekend and early in the day discharges safely.

Ensuring Patients are Cared for in Their Own Homes

Considers pathways to support avoiding attendance, and how someone who has an unscheduled care episode can be optimally assessed without need for full admission, if required they will be cared for and discharged to their own home as soon as ready. Anticipatory Care Plans, redirection to appropriate health care practitioner and shift from emergency to urgent care is the focus for sustainability.