The early bird gets the bed… Early discharges to

create early capacity

Aim Statement

Within 12 months, there will be two discharges

or transfers to the Discharge Transit Unit (DTU)

by 9am each weekday from each of the five

Emergency Department (ED) accessible wards.

Background

There is minimal bed capacity within the five ED

accessible wards before 11am each day and

many of the discharges occur between late

morning and late afternoon. Demand for beds

increases from 9am daily with increased ED

presentations and booked surgical cases.

Team MembersSponsor

Ian Hatton – General Manager, Lismore Base Hospital

Project Team Edwina Nilon – Nurse Manager Access and Demand

Shirley Walker – Whole of Health Program Manager

Judi Kolesnyk – Nurse Manager Transfer of Care

Anthony Zuill – Occupational Therapy Acting Manager

Emma Webster – Physiotherapist

Cheryl Hambly – NUM 23 hour unit / Discharge Transit Unit

Dean Byrnes – Pharmacist

Kym Hickey – NUM Surgical Ward

Remy Simpson-Hay – NUM Cardiology/Vascular/Renal Ward

Anthony Mowbray – NUM Medical Ward

Sandra Vidler – NUM Short Stay Medical/Surgical Ward

Mel Ingram - Quality and Safety Manager

Author: Edwina Nilon Position: Nurse Manager Patient Access and Demand Email: Edwina.Nilon@health.nsw.gov.au Phone: 0429 091 661

ECLP Cohort 23

Plans to sustain change• Embedding processes into the structured morning and afternoon

patient flow meetings

• Multidisciplinary use of the electronic patient journey boards

• Consistent morning MDT Board Rounds

• Monitoring of EDD compliance and accuracy with weekly reports

Plans to spread change• Submission of the project to the ACI Innovation Exchange

• Networking with peer sites to improve the potentially expand the

process based on their experiences

Results

Outcome measuresThere are daily transfers to DTU by 9am but not in the desired

numbers yet. The 23 hour ward has increased these numbers

significantly.

Process measures There are transfers out of ED by 9am but not in the numbers

needed to create ED capacity on any given day.

Link to National Standards

• Standard 1: Clinical Governance

• Standard 2: Partnering with Consumers

• Standard 5: Comprehensive Care

• Standard 6: Communicating for Safety

Literature review• A multidisciplinary care pathway significantly increases the number of

early morning discharges in a large academic medical centre (QMHC

Journal)

• Identifying hospitalised paediatric patients for early discharge planning:

A feasibility study (Journal of Paediatric Nursing)

• Understanding and overcoming barriers to timely discharge from the

paediatric units (BMJ)

Process measures continued

Balancing measures

Failed discharges from DTU requiring

re-admission = nil patients

Discussion

Discharge planning is a complex and multifaceted process.

The first phase of the project related to nursing and allied

health interventions however the remainder of the project

will require medical engagement also. Daily discussions

around patients transferred or discharged by 9am occur

and are embedded into the morning patient flow meeting.

Day prior planning and identification of patients for

discharge first thing the following day will be the crucial next

step towards achieving the goal.

Overall Outcome of ProjectWhilst the goal of ten vacant beds by 9am hasn’t been

reached yet, the project is continuing with further

PDSA cycles planned.

There is an increase in the utilisation of the Discharge

Transit Unit overall compared with previous years.

Compliance with Estimated Date of Discharges

(EDD’s) and use of Good to Go’s (G2G’s) has become

business as usual in each ward. In addition to this,

improved MDT Board Rounds and day prior patient

identification and discharge planning from all

disciplines will be key in being able to increase the

numbers of patients being discharged early. Key

successes with multiple transfers by 9am from the 23

hour ward is promising and these processes will be

reviewed and replicated into other ward discharge

processes to try and achieve similar results.

0

1

2

3

4

Number of patients discharged / transferred to DTU by 9am daily (ED accessible wards)

Measure: Transfers by 9am

Median

COVID impact: decreased

hospital occupancy

No. DTU transfers /

discharges by 9am

each day

Transfers by 9am discussed

at AM bed meeting

Increased focus on EDD's and G2G's

Opening of 23 hour

ward

Commenced AM bed

meeting enhancementDesired

direction of

chart is UP