Daily Dynamic Approach in the community: Highland improvement story part one

Key Learning Points

• Identifying peaks in patient discharge to determine patients who could benefit from earlier discharge or from avoiding admission altogether
• Asking community teams to identify what might help them with more effective discharge planning rather than imposing a solution on them
• Key lead with a strong vision
• Engaging staff in the initiative though use of pledges to support local ownership
• Better communication between teams at the acute hospital and community hospitals via the morning huddle
• Dispensing with the morning shift handover to free up auxiliary nurses' time
• A discharge plan that follows the patient from the acute to the community hospital
• Discharge planning across organisational boundaries
• Clear identification of tasks that support the delivery of the estimated date of discharge, and ownership of those tasks by members of the multidisciplinary team

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.