Improving flow of patients on maternity ward – a Quality Improvement Project

Abstract

The necessity for quality and safety improvement initiatives permeates health care. A high quality healthcare system should be safe, effective, patient centred, timely and efficient. In order to achieve this, health services need to continually evaluate themselves and improve the way they work. We are carrying out a Quality Improvement Project to improve patient flow on the Maternity Ward. It is based at Leicester General Hospital, UK which has about 4000 deliveries per year. The hospital maternity ward has 35 beds and postnatal patients occupy 75% of these at most times. Guided by the Pareto principle, we have decided to focus on improving flow of post natal patients through the ward. The first step of our project was to map the journey of a post natal patient through the ward. We studied notes of 25 patients who had been discharged in the past week with the aim to identify bottlenecks in the discharge process where change could be implemented. We were keen to break down traditional hierarchies for this project to ensure that all perspectives and ideas were considered. So we conducted three spot surveys of ward staff such as midwives, student midwives, healthcare assistants and non-clinical staff who are often the first point of contact for patients. The staffs were asked to put forward any ideas and suggestions to improve patient flow through the ward. The suggestions included increasing midwifery staffing levels, having a dedicated ward doctor, a dedicated staff member for administrative tasks including completing discharge summaries, expanding the roles of staff members such as the healthcare assistants and housekeepers. The results of the staff survey were presented to senior staff members whose experience helped us to weigh up each idea. We realized that in the present day climate of the NHS with its many financial constraints, hiring more staff was not an option. The suggestion of having a dedicated ward doctor was well received. This could help streamline and speed up the discharge process by ensuring timely review of patients, and medication prescription. We conducted an anonymous survey of ward staff and junior doctors putting forward this idea and received a positive response. In response to another survey question, 100% of the respondents also indicated that the present postnatal patient discharge system needed change and reorganisation. At present we are working on implementing this change in our unit. Once this PDSA (Plan, Study, Do and Act) cycle has been completed, we will conduct staff surveys to assess satisfaction level with this change and compare it to the previous survey results. We will also compare patient discharge timeline to the previously collected data and see if the change has resulted in shortening the discharge timing. We hope to achieve a sustainable change which makes a real difference to patient care in the maternity ward and ultimately has a positive impact on patient safety.