Outstanding healthcare improvement project
Quality Improvement Project: UK
Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venous thromboembolism, hospital acquired infections, prescription errors, and falls.
Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result.
The medical staff at Wexham Park Hospital, Berkshire, UK, carried out a prospective audit based on the collection of information about patients during their process of care. They wanted to investigate if simple ward behaviour modifications could increase patient flow, speed up the safe discharge of elderly patients, and reduce LoS of inpatients awaiting social packages and placement.
Adherence from the outset was promising; a collective approach included input from all staff, who responded well. The multidisciplinary team accurately collected data from all medical ward rounds, and the ‘computer on wheels’ at bedsides functioned appropriately.
Ward clerks and senior nursing staff were encouraged to attend hand over meetings and help in the completion of ward jobs so that there was no delay in starting the midday and evening meetings. A roll-call was also held at the beginning of each and every meeting to ensure that all members were present. A member of the IT department was also elected to chair the hand-over meetings, and each patient was discussed during the three structured meetings throughout the day. Finally, the project formed part of junior doctors’ induction.
After five months of data collection, the multiple daily ward meetings, rounds, and evening bedside reviews successfully shortened the time taken from a patient’s admission to medically fit for discharge status from 21 days to 15 days. It also decreased the discharge process from 25 days to 1 day over the 5 month period. Overall, the quality improvement intervention successfully reduced the length of stay for hospital inpatients by 65%.
BMJ Quality Improvement Reports publishes quality improvement work, original research and reviews. The online-only, open access journal covers all aspects of quality and patient safety in healthcare.