reducing length of stay
DESCRIPTION
A presentation by Dr Imran Waheed, Consultant Psychiatrist, on strategies to reduce the length of stay of psychiatric inpatients. Delivered in Birmingham, UK in July 2010.TRANSCRIPT
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Strategies for Reducing Length of Stay
Dr Imran Waheed19th August 2010
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Introduction
Patients - Recovery is impeded, future resilience lower
Fiscal - reducing LoS by 1 week for just 100 patients a year would result in £150,000 saving – if you do that for 1000 patients you save £1.5 million
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Future Strategies
“Problems cannot be solved by the same level of thinking that created them”
Albert Einstein
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Ten Strategies for Reducing Length of Stay
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(1) Robust Data/Analysis
Use robust scientific data to analyse LoS, peak times for admissions, peaks and troughs of bed occupancy
Clinicians need to have access to this data on a real time basis
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(2) Eradicate Treatment Delays More efficient admission procedures –
patients must arrive with treatment plans and treatment charts; speedy and judicious use of medication
Expected discharge dates on admission
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(3) Ward Reviews
Daily ward reviews – counter intuitive that we admit 7 days a week and discharge once a week.
Need to deal with the resistance to change that exists on some inpatient wards
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(4) 10 am Discharge Policy All patients identified for discharge must
be ready to go by 10 am Medication ordered Transport arranged Beds available for admissions in the day
– avoids overspill into “out of hours” Accommodate patients in day
rooms/areas once waiting for discharge
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(5) Using Technology
Real time bed status/LoS information – use of electronic whiteboards
eCRS - computers and projector/electronic whiteboard in ward review – patient records immediately available, entries made in notes at the time of the ward review
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(6) Out of Hours
We admit 7 days a week and discharge 5 days a week
Senior medics are present for about 220 days out of 365 days in a year
Evening ward reviews at hubs Saturday ward reviews by consultants to
identify possible discharges Aim for all patients to be seen within 24
hours by a senior medic
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(7) Interface
We need to work on the “pulling” mechanism
CMHTs need to pass people back to primary care
AOT passing patients back to CMHT Regular (lunch) meetings between
inpatient, CRHT, CMHT and AOT.
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(8) Widen the net
The focus should not only be on “delayed discharges” but we should seek to reduce the LoS for all patients
Majority of inpatients are not “delayed discharges” – modest improvements will have a significant impact
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(9) Bed Management
Need more medical input in bed management
There is an argument for decentralisation of bed management and giving clinicians greater responsibility for beds.
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(10) Triage ward
Consider setting up a short stay triage ward that directs patients to inpatient ward, home treatment or CMHT
In Lewisham (SLAM) this led to 42% of admissions to the triage ward being discharged in 7 days
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Strategies for Reducing Length of Stay
Thank you...Any Questions?