The SAFER Patient Flow Bundle
Staff on Ward 3B highlighting the importance of the #endpjparalysis campaign for patients to Get Up, Get Dressed and Get Moving to aid recovery
#EndPJparalysis - CUH supports #endPJparalysis
Patient Information Leaflet
Physiotherapy Patient Flow Initiative
A new model of patient scheduling was put in place by Physiotherapy OPD staff and clerical officers working together.
Patient waiting times have reduced and there has been a high level of patient satisfaction reported.
The advantages of the new system are:
- Improved outcome of injury
- Improved patient pathway
- Less administration time
- More self management by the patients
- Proactive approach to the waiting list
- Less patient complaints
Speech and Language Therapy Patient Flow Initiative
The unscheduled care change programme, of which Project Flow is an integral part, was introduced to develop new initiatives to improve the patients’ pathways in CUH. It encouraged a culture of change to be fostered and developed across the Hospital and within individual Departments. This call to arms required the commitment of staff to continue to implement change at a time of very constrained resources to significantly improve patient pathways and outcomes (Unscheduled Care Programme CUH November 2017).
The SLT Department took on this challenge with courage and sought to re-build our systems and processes to effect positive change for both our patients and our staff. This change management was cost neutral and occurred during a period of time when there was a 30% increase in referrals to our service.
What did we want?
To see referred inpatients as timely as possible, to commence inpatient/hospital episode of care earlier to and get patients discharged safely with the best possible outcomes.
What were we doing prior to 2017?
The SLT Department delivers a service to all referred patients across 4 sites; CUH, CUMH, St. Finbarr’s Hospital and Mallow General Hospital. Pre 2017, the CUH staff base were generically assigned to referrals; inpatient and outpatient referrals were actioned without any defined system to determine response times.
Inpatient waiting times were falling below professional standards where inpatient referrals should be responded to within 24-48 hours of receipt of referral. CUH SLT response times ranged from an average of 2-4 days, with recorded delays of up to 7 days.
Why was this not working?
- Nil transparency re SLT response times to referrals
- Ward frustration as nil designated point of contact for patient advocacy and
- Ward frustration as other HSCP groups had designated Staff to each Ward and SLT had been unable to apply the same principles due to paucity of resources
- Patients with delayed discharge whilst awaiting assessment
- Department was unable to meet professional standards
- Poor Staff morale; daily Department allocation meeting to try to assign referrals led to daily frustration from Management and Staff given difficulty managing caseloads.
- Limited Leadership framework in the Department due to the generic roles of the Therapists; poor development of Senior Staff
- Culture of crisis management /Reactionary culture
- Nil improvement in response times despite the introduction of on-line referrals (iCM)
What did we do?
In 2017 we commenced our change management project as reflected in the ethos for project flow. This resulted in:
- Rollout of a standard Department prioritisation system; providing an objective measure of clinical risk which dictates response times to referrals and a framework to manage existing caseloads.
- Wards were cohorted according to services with Senior Therapists designated as Clinical Leads for each Ward cohort
- Staff Grades were assigned to each Ward cohort on a rotational basis
- Buddy groups were established to facilitate support for annual leave/CPD leave/times of increased service pressure
- Senior Staff given the responsibility for contingency planning to ensure cover for buddy group when resources depleted by annual leave/CPD leave
- OPD Caseloads managed via a defined clinic system by rotating Therapists
- Development of a mandatory system for professional supervision to enable a culture of positive accountability and commitment to the development of all Staff within change management.
The results so far: #we are awesome
We are very proud to report that in an audit of service delivery since the initiation of this project in January 2017 all in-patient’s referred to the SLT service in CUH are seen within 1-2 working days of receipt of referral. This is compared to 2016 when waiting times ranged from 2-7 days. All patients within our high-risk categories are seen within 1 working day. This improves patient safety and experience and reduces the risk of prolonged Hospital admissions related to aspiration pneumonias. Our visibility on the wards has improved and all CNMs have a point of contact for their patient care. This, in turn, is making service development more achievable in all clinical areas, and is having a beneficial impact on striving towards the gold standard of patient care, ‘THE RIGHT CARE DELIVERED AT THE RIGHT TIME IN THE RIGHT PLACE’ . We have achieved so much that we can be proud of. Our systems and processes are lean and efficient. However, this will be challenged on a daily basis and we are working hard to enable all Staff to manage and sustain the change in the context of ever increasing demands.