Further Opportunities Possible actions for achievement Title of Urgent & Emergency Care (UEC) TIPS REGARDING FORMATTING Use graphic elements, like boxes, to highlight each section of your poster. Use space to create emphasis. Use no more than 2-3 colours, and dark type on a light background. Conclusions first, keep them short and to the point in the upper left-hand corner. Simple graphs are effective graphs. Make the text big enough to read. Use Arial or Lato font. ALWAYS left align the text. Keep your headings the same size and style throughout. Avoid chaos, keep the layout easy for the eye to follow. Images and graphs say more than words, so keep your poster visual. If you are using a photo, avoid web images – use at least 150 dpi, but no more than 300 dpi. Don’t forget any other logos where necessary. Healthy London Partnership: UEC Improvement Team QEH: Implementing a ward-to board process to reduce the number of long length of stay patients (>21 days) on wards Queen Elizabeth Hospital (QEH) has been a consistently high bed occupancy rate, with high occupancy from long length of stay (LLoS) patients. LLoS reviews were implemented to reduce the unnecessary stay of patients in a hospital bed and improve flow from ED. The improvement support offer between QEH and Healthy London Partnership (HLP) included: Review of current status of current operating model on LLoS patients Lead on training sessions with ECIST on benefits of LLoS reviews and use of ECIST tool Engage with Exec Team and system partners to increase awareness and collaboration to enable development of LLoS reviews and unblock issues Use a QI approach to ensure a site-based co-designed model for embedding ward-based LLoS reviews agreed Identify system-wide opportunities to improve discharge processes, including aligning programmes of work, governance structures and reviewing impact of current processes. What we did Scope of impact Barnet Enfield Haringey Camden Islington City Barking and Dagenham Hackney Havering Newham Redbridge Tower Hamlets Waltham Forest Croydon Richmond Wandsworth Kingston Merton Sutton Brent Ealing H&F Harrow Hounslow K&C Westminster Hillingdon Lambeth Bromley Bexley Greenwich Lewisham Southwark Approach Delivery HLP/ECIST led training sessions on value of LLoS reviews and harm caused by long stays System-wide engagement to share rationale and benefits of reviews Planned small scale pilot roll-out of reviews on four wards wards Ward level coaching to promote discharge remit Co-design, implement and support delivery of LLoS Reviews – initially office-based, then on wards Link site with UEC ‘Once For London‘ improvement work: Enhancing Health in Care Homes, CarePulse, NHS 111 Star lines Facilitated meetings to introduce LLoS reviews, with key stakeholders at QEH and Bexley/Greenwich system partners Introduced and delivered training on the ECIST LLoS toolkit Used QI methodology to implement and continuously improve the conduct of reviews Connected the ToCC team with several pan-London community-based UEC programmes Established a weekly cycle for LLoS reviews, including membership, capturing data, escalating actions Highlighted further opportunities for improvement, including clarifying discharge team responsibilities, ward-based discharge training, developing robust system-wide escalation processes TIPS REGARDING FORMATTING Use graphic elements, like boxes, to highlight each section of your poster. Use space to create emphasis. Use no more than 2-3 colours, and dark type on a light background. Conclusions first, keep them short and to the point in the upper left-hand corner. Simple graphs are effective graphs. Make the text big enough to read. Use Arial or Lato font. ALWAYS left align the text. Keep your headings the same size and style throughout. Avoid chaos, keep the layout easy for the eye to follow. Images and graphs say more than words, so keep your poster visual. If you are using a photo, avoid web images – use at least 150 dpi, but no more than 300 dpi. Don’t forget any other logos where necessary. Greenwich HLP has supported LLOS (Long Length of Stay) Reviews HLP has supported MADEs (Multi Agency Discharge Events) HLP has supported both LLOS Reviews and MADEs Progress Update Further Opportunities Organisational and stakeholder engagement Good trust executive team support; ward and the discharge staff committed to improving the management of long stay patients Moving LLoS reviews from office based to wards Opportunity to avoid duplication of discussions at ToCC meetings and output from LLoS reviews Workforce Clinical Lead and admin support identified to co-ordinate LLoS review activities Support established from the medical director to clinically review unfit patients Lead Occupational Therapist embedded in LLoS review team, providing effective challenges Opportunity to improve on data collection and IT analytical support of data and performance Governance In the process of establishing formal governance structure for escalations from ToCC team Development and embedding of LLoS reviews now part of the QEH Emergency Care Improvement Programme of work, encompassing all improvement activities System-wide partnership opportunities to improve upon collaborative working, promote Enhanced Healthcare in Homes and Alternative Care Provision Weekly patient reviews Opportunity to reduce knowledge variability at ward level Coding consensus on why patient waiting, leading to accurate reporting for escalation Ward-based reviews ensure full capture of clinical and patient picture Further discipline and challenge required around the community offer and support Metrics required to understand impact and outcomes of discharge process Recommendations Possible actions for achievement Confirm the approach for reviewing both medically fit and unfit patients across the hospital Pilot clinically-led “complex cases” meeting Review clinical pathways for discharging, to include board round discussions; early discharge planning Review interface with system partners and D2A model – promote and maximise on community offer Obtain baseline data of current discharging profile Stakeholder engagement; gap analysis of what is happening v. what should happen; clarification/re-education of D2A model Embed DPTL Toolkit and improve the overall programme leadership for LLoS reviews and align to the wider governance arrangements at QEH Identify a Clinical Lead for the LLoS programme of work Agree a governance process to clarify patient flow escalations through site processes Align implementation of LLoS review improvement work with wider improvement programmes To find out more, please contact: Eileen Sutton eileensutton@nhs.net Sudipinder Sian sudipinder.sian@nhs.net @healthyLDN