Together, we can improve flow throughout our hospitals

Dr Francesca Cleugh, children’s emergency medicine consultant and deputy director of innovation and improvement, is focused on making improvements in our hospitals. This autumn, Francesca and a small team of staff from across the organisation are working alongside staff in over 60 inpatient areas to support wards to make improvements that will help patients who are well enough for discharge leave hospital sooner. Here, she explains how wards can set themselves up for success each day and why now is the time to make improvements.

We know that patients do best when they leave hospital as soon as they are medically ready to do so. But lots of things need to align to ensure that happens as quickly as possible and some patients can have days in hospital where nothing happens to advance their care or help them get home.

One proven way to help address this issue is a ‘board round,’ a daily meeting where a ward’s multidisciplinary team reviews each patient and discusses their care plans. The aim is to ensure every patient has a productive day in hospital, and patients who are nearly ready to leave hospital are prepared for discharge. Productive board rounds can help improve flow across all of our hospitals.

Over the next few weeks, a small improvement team from across the organisation will visit all inpatient areas to observe board rounds and discuss how we can make the most of these sessions. This is not an inspection – we want to understand how each team’s approach to board rounds affects what happens on their wards and identify manageable ways we can support them to improve. We also want to connect teams so they can learn from each other.

Running high-quality board rounds

We’ve developed a factsheet that captures the key ingredients for a board round that will help improve flow on each ward and throughout the hospitals as a whole. A great board round happens each day and should be focused on actions that will move each patient closer to discharge. A high-quality board round should:

  • happen every day
  • happen early in the day
  • include as much of the multidisciplinary team as possible

At the board round, when each patient is discussed, the team should confirm:

  • an anticipated discharge date
  • whether the patient is ‘medically optimised’ (no longer in need of acute care in hospital)
  • whether the patient has a ‘reason to reside in hospital’ (needs further acute care)

As a team discusses an individual patient at the daily board round, they should update on Cerner the anticipated date of discharge, confirm whether the patient is medically optimised or has reason to reside in hospital, and if they need to stay in hospital, explain why. Improvement work is underway by the Cerner team to make the recording of this information easier. Then, the team can plan each patient’s day accordingly: begin preparing discharge letters, prescriptions and discharge plans for patients who are medically optimised. For those who still need hospital care, ensure something happens – an investigation, a treatment, a consultation with a therapist – to move their care forward.

We know that this is aspirational – it won’t always be possible to tick off every element at every board round. But by focusing our energies on making the best of each board round and ensuring they set us up for a successful day, we’ll all take a step towards improving flow across our hospitals.

Why now is the time to improve

As I finished a 14-hour shift in A&E this week, I reflected on just how challenging things are right now. Our hospitals are so busy, and we’re working hard to stay vigilant about Covid-19 within our walls even as restrictions relax beyond our hospitals. Patients are frustrated with waiting for care and at times they project their frustrations onto us. Everyone has been through so much over the past two years and we carry that with us each day.

That’s why we don’t have time to continue with practices that don’t work as well as they could. We should interrogate what we do, try out small tests of change, share practices that work, and do away with practices that hold us back. If we can work together to support every area to improve – even if that improvement is just one step forward – imagine what we’ll achieve. We have over 60 inpatient areas across the Trust – if each one makes a small improvement to their board rounds that helps improve flow on their wards, that will make a tremendous difference across all of our hospitals.

Next steps

Over the next few weeks and months, we’ll gather insights and learning through ward visits, talking to staff and coaching and supporting them to improve. We’ll share new ideas and examples of good practice, develop some metrics to help assess board rounds and our improvements to them, and connect teams so they can learn from each other. Hopefully, within six months, we’ll start to see a really big difference. In the meantime, every small improvement we make helps patients get home sooner.

Use the hashtag #BetterTogether to share this blog on social and join the conversation about kindness this winter. Staff can find resources to support flow, improvement projects and more on our intranet.