Hospital Operational Standards Jennie Hall, Chief Nurse Dr Ros Given-Wilson, Medical Director Martin Wilson, Director of Delivery and Improvement

Emergency department 2 - Whole hospital emergency pathway 3 - Wider health system Ensuring an effective and high quality urgent and emergency care requires action across the whole system

2 The Trust’s Operational Management Team have agreed a set of operational standards Discharges by 12noon Discharges by 4pm There will be a consultant presence on each ward every day of the week Every patient should have a consultant approved EDD completed within 12 hours of admission; Criteria for discharge documented for all patients Daily board rounds (ideally first thing in the morning), where every patients care plan and progress against clear objectives is reviewed every day by a senior doctor. The introduction of “flow bundles” for each clinical area along the pathway There should be weekly review of patients with LOS exceeding 5 days. ILLUSTRATIVE

3 Patient Flow Bundle All designed to deliver better patient care through improved patient flow Key initiatives to be delivered systematically on each ward They are seen as being able to deliver the greatest potential impact An explicit small set of interventions and clear parameters that, when delivered together, as part of a multidisciplinary approach, help to deliver the best possible care

4 Board Rounds Ward Rounds Criteria Led Discharge EDD Length Of Stay Reviews Patient Flow Bundle Right Patient Right Environment Right Time

Enables patients to receive optimum care for their specific needs and discharge is planned accordingly Patient receives the right care, in the right environment, by the right people, at the right time. Patients are discharged in a timely manner at the date and time set, (tbc) % by 12noon and 4pm Ward Rounds Daily morning ward rounds, on every ward, using a standardised approach, will facilitate the development of clear patient management plans Ward Rounds Daily morning ward rounds, on every ward, using a standardised approach, will facilitate the development of clear patient management plans Criteria Led Discharge A patient’s management plan should consider a facilitated discharge based on defined criteria Criteria Led Discharge A patient’s management plan should consider a facilitated discharge based on defined criteria Length Of Stay Reviews A weekly systematic review of patients with extended lengths of stay will identify the issues and actions required to facilitate discharge Length Of Stay Reviews A weekly systematic review of patients with extended lengths of stay will identify the issues and actions required to facilitate discharge Board Rounds A daily morning board round, on every ward, facilitates goal setting and action planning and enables the ward round to be prioritised Board Rounds A daily morning board round, on every ward, facilitates goal setting and action planning and enables the ward round to be prioritised Expected Date of Discharge (EDD) All patients receive an EDD within 24hrs of admission and discharge is planned around this date Expected Date of Discharge (EDD) All patients receive an EDD within 24hrs of admission and discharge is planned around this date Drivers Content Interventions Patient Flow Bundle

The Patient Flow Bundle Expected Date of Discharge (EDD) helps the Hospital to plan and understand its available capacity at all times – it must be up to date Has the patient’s EDD been set within 24 hours of admission? Has the EDD been reviewed and, if necessary, updated each day? Is the EDD realistic and does it reflect the actual date and time the patient is expected to go home? Is the patient aware of the date and time they are expected to go home? Expected Date of Discharge (EDD)

The Patient Flow Bundle The Board Round introduces structure to the day to day running of the ward and helps the ward team to manage the patients safely and effectively Consider sick and unstable patients first – is the patient deteriorating? What actions are required? Are there any patients to be discharged today/tomorrow? What needs to be done to ensure they go Home 4 Lunch? Have new patients been given an EDD that the MDT agree on? Are there any delays that need to be expedited? Board Rounds

The Patient Flow Bundle Ward Rounds The medical ward round should promote a consistent organised and disciplined approach to ensure an efficient use of time and resources, ensuring care is coordinated appropriately The ward round should follow the board round in the morning each day Patients should be seen in a specific order: Sick unstable patients Potential discharges The remaining patients A record of the round, with clear management plans, should be written in the patient’s notes TTOs should be prescribed and diagnostics ordered in real time

The Patient Flow Bundle Criteria Led Discharge facilitates a smoother discharge by non-medical members of the MDT for patients that are deemed fit, provided certain defined criteria are met Consider a simple and timely discharge undertaken by nursing staff using agreed criteria The patient’s TTOs and discharge letter will be completed by the medical team Clinical criteria must be set by the medical team with functional and social criteria discussed by the MDT, and recorded in the patients notes Criteria Led Discharge

The Patient Flow Bundle We need to proactively respond to the identified delays through appropriate action planning Do all patients have clear management plans for their medical care within the medical record? Is the patient waiting for any procedures or tests? Do these need chasing? Have you applied the Golden Rules for Discharge? Have you considered whether the care of the patient can be provided in an alternative setting rather than an acute hospital Length Of Stay Reviews

Benefits Patients will benefit from improved care coordination ensuring they receive their care in a timely manner in the right environment Patients will benefit from a well planned, timely discharge Staff will benefit from being able to provide patients with the specialist care for their needs Staff will have all the information they need to ensure care is delivered appropriately Staff will be able to deliver real time, accurate information to the Site Management Team and ensure the Ward Information System is up to date The Trust will benefit from improved patient flow throughout the organisation The Trust will benefit from having meaningful information to enable capacity and demand to be managed