Milton Keynes Hospital NHS Foundation TrustCase Study – Lean Patient Discharge
Lean Patient Discharge Case Study
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Case Study – Lean Patient Discharge Milton Keynes Hospital NHS Foundation Trust Context & Issues Process Improvement Technology to support the process
Design for the Future
There has been discussion about patient Discharge Summaries for over 20 years
• Patient discharge summaries have been a part of the patient record and communication to GPs for approximately 100 years
• The value and content of summaries / letters has been debated since at least 1986¹ (perhaps longer) both in the UK and abroad
• In recent years constructive interest seems to have gathered pace …• Wilson² observed the need for electronic discharge summaries• Munday³ pointed out the need for more information about drug
changes was needed• The DH produced a discharge pathway process in 2003
• … Such that the NHS Institute for Innovation & Improvement produced• Achieving timely ‘simple’ discharge from hospital, 2004
¹ Structured discharge letter in a department of geriatric medicine, Howard, 1986² GP-hospital communications-A review of discharge summaries, Wilson et al, 2001³ Do GPs & Pharmacists want information on the reasons for drug therapy changes implemented by secondary care, Munday et al, 1997
The NHS Alliance raised the profile of the debate this year
• A Very Present Danger – A national survey into information provided by hospitals to GPs when patients are discharged¹
• The findings:
¹ A Very Present Danger – A national survey into information provided by hospitals to GPs whenpatients are discharged, NHS Alliance, Feb 2007
In addition to poor information about care, the patient experience¹ of the discharge process is less than ideal
• 27-43% of patients have their discharge delayed• 55-63% have to wait for medicines• Of those delayed 20-27% have a delay of ≥4hrs• 42-75% did not receive a copy of a letter from
the hospital to the GP• Despite Department of Health guidance²
¹ Inpatient Questionnaire, Picker Institute, 2007
² Copying Letters to Patients, Department of Health, 2003
The impacts of producing poor discharge information are significant to the patient and hospital
• Continuity of care is disrupted• Community-based care, including social care and support, is harder to plan and
organise• Patient safety is at risk
• The NHS Alliance survey respondents have provided anecdotal information that patient care is compromised
• The risk of readmission may be raised• van Walraven¹ pointed out “The risk of rehospitalisation may decrease when
patients are assessed following discharge by physicians who have received the discharge summary.”
• Hospitals revenues are under threat• NHS Alliance has called for discharge summaries to be a contractual obligation …• … Evidence is that this is happening locally• PCTs are linking payments to improved discharge information improvement
• Impact on pharmacy operations and fulfilment• Illegibility is dangerous• Amendment of shorthand and poorly defined prescriptions is time consuming• Amended forms are harder to read
• Impact on Clinical Coding• De-ciphering treatment details can be next to impossible … and be very time
consuming
¹Effect of Discharge Summary Availability During Post-discharge Visits on Hospital Readmission, 2002
Inte
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2. Completion
1. Initiation
On the Ward:At the time of admission & treatment
At point of discharge decision
In Pharmacy:Modified if necessary
Verified as complete:
At point of discharge
Started on admission or initiated at time of decision to admit
Demographics & admission data fields auto-populated from Millennium
3. ‘Transmission’
GP receives a copy
Patient receives a copy
Clinical Coding informed of discharge
Coded electronically
Enters patient’s eMedical Record
Less paper
Overall Design
WebService
HSS
Radiology Legacy PAS
ClusteredBizTalk 2006 R2SQL Server 2005
Trust Integration Engine
Message ReplayBizTalk 2006 R2
Pharmacy
Pathology
ADT
ADT
SQL Server 2005
Patient Master Index
ADT SQL Server 2005
Data Warehouse
ADT
GPs
SharePoint 2007InfoPath 2007Active Directory
eDischarge Summary
ADT
SQL Server 2005
Trust Dashboard (2008)
Clinical & Admin data
ADT
ADT
Milton Keynes Architecture
AudiologyMaternityother Dept’l Systems
ADT
Nine eDS Benefits
1. Provides GPs with the patient information they have defined as necessary
2. On completion makes the Summary available to GPs immediately
3. Provides a legible record of treatment and planned after-care to the GP
4. Provides a standard format for prescribing TTOs5. Reduces completion time by auto-populating selected
fields6. Allows Pharmacists to make amendments to
prescriptions without ‘defacing’ the Summary7. Improved workload management in Clinical Coding8. Provides an interim solution until CRS is able to meet the
needs of the GPs and PCT9. The Hospital gets paid!
Milton Keynes Hospital NHS Foundation TrustCase Study – Lean Patient Discharge
ABOUT WCI
