Quality Improvement Project For Patient

Discharges at 3pm

Dr Muntasha Quddus – FY1

Introduction

Earlier discharges are safer for patients, especially in the elderly population. The Leeds Teaching Hospitals Trust’s discharge collaborative team have set 3pm as the deadline for when patients should ideally be discharged by. This way patients can be home in daylight, with any support needed and they can eat and sleep at home. It also improves the flow of beds in the hospital, further improving patient care. Overall earlier discharges can help both patient care and safety and with the curre nt pressures in the NHS it is imperative we do all we can to manage the increased demands safely.

After discussion with fellow junior doctors and the discharge co-ordinators it was identified that the limiting factor to timely discharges is completing the discharge medication prescription (eMeds) on our electronic discharge advice note (eDAN). Only once this has been completed by medics can the pharmacist access it, check it and dispense the medication. Therefore I wanted this project to tackle this issue and to investigate how we could ensure that the eMeds can be done in a timely manner for patients who are or are approaching a medically optimised for discharge (MOFD) status.

Aim

Increase patient discharges by 3pm to 80% in J14, an elderly medicine ward, over 3 months.

Cycle 1

Study

Act

• Trying to get the discharge medications prescription completed as soon as possible

• Therefore allowing time for pharmacists to check and dispense the medication

• Up to 45% of discharges took place before 3pm .

Do

Reflections and further plans

• At the beginning of MDT we would always identify the MOFD or approaching MOFD patients so we could prioritise they discharge prescription.

• Within a month 45% of the patients were discharged by 3pm

• This was only slightly above the trust average as highlighted on Fig 1

• Even though we had limited data it was quickly identified that we needed a better way to keep track of patients who could have their eMeds completed.

Plan

• Identify patients during are MDT either approaching MOFD or those who are MOFD

• Unlikely their medications will change so trying to prioritise their discharge medication prescriptions

• Making a mental note of those patient who are MOFD or approaching MOFD and completing their discharge medication prescriptions.

• Usings the trusts bi-weekly data sets to assess progress

Act

• Need a more permanent way to address which patients can have their discharge medications completed.

Study

• In the second month 82% of our discharges were before 3pm!

Cycle 2

Plan

• Identify during MDT which patients were MOFD and would not have changes to their medication

• Adding an extra eMeds box to the ward discharge board

• Ticking off this box when the discharge medication prescription has been completed

Do

• Allocation a team member to complete the discharge board (Fig 2).

• Ensuring this is ticked off once completed so other doctors are aware which one are completed and which one still need to be done

Reflections and further plans

• The ward already had a discharge board, so I decided to add an eMeds box that could be seen by all to remind us to prioritise the discharge prescription ( Fig 2).

• This was a quick, cheap and easy intervention without making MDT any longer.

• My team also made a real effort to keep that board up to date by allocating someone to complete it during MDT.

• This paid off as 82% of our discharges were before 3pm in the second month (Fig 3).

• However, in the next month 68% of our discharges were before 3pm

• The discharge board had been effective but more needed to be done

• For the next cycle I will investigate individual patients who were discharged after 3pm to identify why that may have happened and use that data to develop a new plan to tackle those issues.