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Improving the Patients Journey for People with Learning Disabilities

This project aims to streamline and improve the processes and procedures of pre-assessment, admission, and discharge for patients with learning disabilities, reducing length of hospital stay and increasing patient satisfaction.

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Improving the Patients Journey for People with Learning Disabilities

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  1. St Mary’s patient pathway project Stephan Brusch – Service Development Manager Westminster PCT Mark Sheen - Community Nurse Specialist Kensington and Chelsea Learning Disability Service

  2. SETTING THE SCENE • High rates of poverty and deprivation centred in specific wards • Indices of deprivation (2004) Westminster 39th and K&C 166th out 354 English districts • Up to 18 year difference in life expectancy for people living in the wealthiest and poorest wards

  3. SETTING THE SCENE cont…. The project involved: • St Mary’s NHS Trust • Westminster Learning Disability Partnership • Kensington and Chelsea Learning Disability Service

  4. PAST WORK AND CHALLENGES • St Mary’s Disability Group • Teaching, video’s, accessible information • Limited effectiveness • Difficulties in effecting a systems change

  5. Opportunity • Established link with the Modernisation Board at St Mary’ • Body that oversees Transforming St Mary’s

  6. What is Transforming St Mary’s? • A programme of coordinated projects addressing the use of new technology, new roles and new processes • The programme uses a structured approach to project and programme management, and each project reports to the Transforming St Mary’s Board Programme Board

  7. Aim - To improve service efficiency and effectiveness of the trust, for the benefits of staff and patients • Objectives – To ensure patients are treated in the right place at the right time by the right staff, to provide safe, high quality care.

  8. What are the projects? • IT • Picture Archiving - electronic capture & storage of X-rays • Order Communications - electronic ordering & reporting of diagnostic tests • Electronic Discharge Communication - electronic GP discharge letters • Choose and Book - direct booking of out patient clinics from GP surgeries • Roles • St Mary’s 24 / 7 – redesigning rolese.g. Outpatient Clinic Assistants • Processes • Improving the Patients Journey – streamlining processes and procedures from pre-assessment to discharge

  9. Improving the Patients Journey • Aims • To streamline, standardise and improve the processes and procedures of pre-assessment, admission and discharge • Objectives • To reduce length of stay for patients • To increase % of patients who receive pre-operative assessment • To increase % of patients who are given an expected date of discharge

  10. Why did we get involved? • As part of Improving the Patients Journey (IPJ) project the trust was redesigning the patient journey from pre-assessment to discharge • A proposed pathway was designed. • What impact did this pathway had on vulnerable patients?

  11. The St Mary’s project: • A defined patient pathway agreed by community and hospital staff.

  12. Project Objectives- The Outcomes: • Improved patient experience for people with learning disabilities and their carers

  13. Project Objectives- The Outcomes: • Decrease the number of inappropriate admissions by increasing the number of people who can be treated in the community. Community

  14. Project Objectives- The Outcomes: • Length of hospital stay in line with the general population

  15. Auditing Records: • We looked at records of people who stayed at St Mary’s. • We wanted to see what worked well and what didn’t work well.

  16. Consultation: We arranged a workshop and looked at the following areas: • Going into hospital • Staying in St Mary’s • Leaving St Mary’s and A&E

  17. This is what came out of the mapping exercise: • Pre-admission • Inpatient stay • Discharge and A&E

  18. Pre-admission Training

  19. Pre-admission Ensure people have access to primary care

  20. Pre-admission Re-launch communication tool

  21. Ensure that St Mary’s can identify people with learning disabilities and their support needs.

  22. Inpatient stay Better information when arriving at St Mary’s .

  23. Inpatient stay Better training and information on consent and best interest.

  24. Inpatient stay Better information while staying in hospital.

  25. Accident and Emergency Better triage in A&E

  26. Accident and Emergency Training

  27. Discharge Better communication at discharge.

  28. We included everything in an action plan and set priorities.

  29. Next Steps: • Transforming St Mary’s Programme Board • Partnership Boards • St Mary’s Disability Group

  30. Reflective Learning Points • Gather data and link to national evidence (audit and user involvement). • Moving away from focussing on patterns (people’s behaviour) to influencing processes • Mainstreaming (transferability to other vulnerable groups, process mapping) • Being politically astute (create win-win situation) • Be a strategic Health Facilitator

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