1756 Improvement in the number of discharges prior to 3 p.m. using quality improvement methodology

Abstract

Abstract Introduction Under current nationwide clinical pressures, hospitals are running at full capacity. Late discharges can lead to poor flow throughout the hospital, overcrowding in the emergency department and out of hours transfers, leading to a poor patient experience and impacts on patient safety. Early morning and afternoon discharges create better flow and improve patient satisfaction, by being home in time for tea. The discharge collaborative within Leeds Teaching Hospitals NHS Trust is a multidisciplinary team (MDT) of junior doctors, pharmacists, nurses and discharge co-ordinators. The aim of the team is to improve discharges in the trust prior to 3 p.m. to 70%. Discharging patients earlier in the day is a complex multifactorial issue which requires an MDT approach. Method To understand this further a retrospective case note review was conducted to look at avoidable and unavoidable causes of delayed discharges. Each team also received a questionnaire, to discover their perceived barriers to early discharges. This was communicated to teams to empower them to develop their own solutions which were shared within the trust. Run charts of discharges before 3 p.m. are published for each ward in the hospital every two weeks, which is available to wards, but also monitored by the discharge collaborative. Changes to practice include; education of the medical team regarding importance of timely discharge, use of discharge boards, the increase use of discharge lounge, identifying ‘golden patients’ for early morning discharges, prioritisation of community discharges the previous day and achievement recognition for wards with the most improvement. Results/Conclusions Within the trust, several departments have improved their discharges prior to 3 p.m. through the improvements implemented from the discharge collaborative, including speciality and integrated medicine (SIM), oncology, and trauma services. This project resulted in two step improvements within the Trust with 40% of patients being discharged before 3 p.m.