Length of stay is the number of days a patient stays in a hospital bed as an inpatient. In many cases, a patient can stay in hospital much longer than they need to, waiting for treatment to start, waiting for reviews or waiting for scripts.
Reducing unnecessary length of stay by ensuring that the patient journey is efficient and streamlined means a patient can get home sooner.
Reducing LOS improves patient safety by reducing the risk of hospital-associated harm, which contributes to an even longer stay, and increases bed and staff capacity, enabling us to care for more patients.
In late 2017, the General Medical team began a project to reduce the acute length of stay at St Vincent’s. The team identified problems with discharge planning, which led to the ‘Countdown to Discharge’ (CTD) project being implemented in February 2018.
This new process has been very successful, resulting in CTD being implemented across the health service using five key CTD principles.
Everyone plays a part in a patient’s discharge experience. This key principle ensures the multi-disciplinary team are engaged at a local level when developing a standard discharge process.
Estimated Discharge Dates (EDDs)
Reviewing these everyday with the multi-disciplinary team ensures a consistent message is communicated with patients and their families.
This principle is the formal documentation of the discharge standard that the multi-disciplinary team develop and agree upon. It outlines who does what, when, where and how to ensure there are no assumptions or confusion around roles and responsibilities.
Using visual tools such as the Electronic Journey Board (EJB) and patient bed boards mean all staff and patients have another way to quickly and easily see discharge plans.
Are we doing what we agreed we would do? This daily control principle comes in the form of daily huddles where the multi-disciplinary team meet to discuss all patients EDDs, ensure everything is on track, pick up problems or delays and problem solve these together or escalate via the Daily Management System. Short, structured daily huddles are the glue that holds the entire discharge process together.
The third round of departments are now implementing CTD in their areas. As well as benefitting from a standardised discharge process, staff are also enjoying sharing learnings and problems between departments. Staff capability to implement change and problem solving together is growing, an amazing outcome.
“Every one of our patients has an estimated discharge date that is routinely updated twice a day, or when their plan changes. This date is visible for patients, next of kin and staff, and can be seen within three seconds of walking on to the Ward.”–Sue White, NUM 7E
“Our multidisciplinary team was involved right from the start. Each discipline has contributed to the changes we have made, which has led to the evolution of a sustainable process that we all get great benefit from every day.”–Sally Kemp, NUM 4E
“Having a visual board such as the EJB has been an integral part of facilitating better discharge planning from the multidisciplinary teams, enabling timely reviews and improved patient flow and ultimately enhancing the patient’s experience.”–Samantha Blade, NUM 8E