Patient flow

PRH Emergency Department: Perfect Week (2023)

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Type of publication:
Service improvement case study

Author(s):
*Laura Wild

Citation:
SaTH Improvement Hub, December 2023

Abstract:
I will improve the number of walk-in patients triaged within 15 minutes by 3rd of December 2023. To improve patient flow within the department from initial assessment to Fit to Sit by 3rd December 2023.

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Acute Floor Review 2023 (2023)

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Type of publication:Service improvement case study

Author(s):*Hannah Pope *Rebecca Houlston *Dr Aruna Maharaj *Madeleine Oliver

Citation:SaTH Improvement Hub, July 2023

Abstract:The introduction of the acute medical floor (AMF) will enable ward 22 short stay to achieve a length of stay of 3 days (4320 minutes) by 31st July 2023.

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Acute Floor Review 2023: Impact on Ambulance Delays RSH (2023)

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Type of publication:Service improvement case study

Author(s):*Hannah Pope *Rebecca Houlston *Dr Aruna Maharaj *Madeleine Oliver

Citation:SaTH Improvement Hub, August 2023

Abstract:The Acute Medical Floor (AMF) will reduce ambulance handover delays <60 mins at RSH by 35% by 31st July 2023.

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Improvement to early morning flow to the Discharge Lounge (2023)

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Type of publication:
Service improvement case study

Author(s):
*Shelbey Fenton-Cook

Citation:
SaTH Improvement Hub, May 2023

Abstract:
To increase overall transfers of patients from the inpatient bed base to the discharge lounge by 10 am, focusing on a target of transferring 2 patients by 8am by 10th May 2023.

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Medicine Flow Coordinators Review (2022)

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Type of publication:
Service improvement case study

Author(s):
*Sharon Huckerby, *Nathan Picken, *Nicola Roach, *Emily Weston, *Donna Moxan, *Liam Allman-Evitts, *Kevin Lloyd, *Cath Tranter, *Aaron Evans, *Becky Bromley

Citation:
SaTH Improvement Hub, 2022

Abstract:
The Medicine Division need to understand if the introduction of the Medical Flow Coordinators has improved the volume of cancelled discharges impacting on flow out of the hospital.

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Improvement to inpatient flow from ward to Radiology (2022)

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Type of publication:
Service improvement case study

Author(s):
*Sarah Brown (Radiology), *Ali Beshir & *Russell Williams (Portering)

Citation:
SaTH Improvement Hub, 2022

Abstract:
It had been identified that scanners were not being utilised fully with downtime noted due to delays in our inpatients arriving for their scheduled appointments. To overcome this problem, the Radiology and Portering teams agreed to partner with the aim of trialling a Coordinator role. Using volunteers from portering, the pilot took place initially on AMU & SAU and increased to other wards as the trial progressed. The coordinators were provided with training from Radiology and a robust communication plan was delivered to stakeholders to share the process being trialled. The results did not conclusively demonstrate any significant change to the outcome measures, but feedback from the wards and Radiology team showed that patient safety and experience had been positively impacted upon.

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Cancelled! Cancelled! An audit on cancellation of paediatric surgical cases on the day of surgery in a district general hospital (2019)

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Type of publication:
Conference abstract

Author(s):
Singh M.; *Annadurai S.

Citation:
Anaesthesia; Jul 2019; vol. 74 ; p. 90

Abstract:
Surgical case cancellation has significant impacts on operating theatre efficiency and the UK loses a substantial amount of money on these cases [1]. A recent prospective study over a 1-week period in an NHS hospital suggested a adult surgical case cancellation rate between 10% and 14% and the majority of these cases were due to non-clinical reasons [2]. It is distressing for the patient and affects outcomes. We undertook an audit regarding cancellation of paediatric surgical cases on the day of surgery at a district general hospital (DGH) to look for various reasons for the cancellations and to evaluate the services. Methods We collected prospective data from the hospital's database regarding cancelled paediatric surgical procedures over a 6-month period from February 2018 to July 2018 in our DGH. Results We found that a total of 70 paediatric surgical cases were cancelled on the day of surgery out of total of 653 paediatric surgical cases, which is an approximately 10% cancellation rate over the 6-month period with a range of cancellations from 7% in May and June to 18% in February. We observed that 76% of the cancellations were of elective cases. We subdivided the reasons for cancellations into organisational, patient, surgical and anaesthetic factors. Among the organisational factors, 23% of cancellations were due to 'unavailable beds'. We observed that 11% of cancellations occurred because patients 'did not attend', 7% of patients were reported as 'sick' and 3% of patients did not follow preoperative fasting instructions. Surgeons cancelled 15% of cases for the reason 'procedure no longer required', whereas anaesthetist 'sickness' was the reason for cancellation in 9% of cases. Discussion Cancellations prolong the waiting list and worsens patient experiences and clinical outcomes. In our audit, we found that the main reasons for cancellations were non-clinical. To improve the surgical reasons for cancellation, we suggest timely rereview of the need for surgery. Although staff allocation is looked at regularly, some cases were cancelled due to the unavailability of staff, which can be improved on. We discussed the idea of seasonal planning of cases. We plan to re-audit with the aim of investigating cancellation rates in elective cases over a 1-year period to also review the cancellation rate during the winter months.

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