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The Sheffield Vision for a 7 Day Service

Right First Time – Redesigning how we discharge patients 7 days a week Dr Andrew Gibson, Sheffield Teaching Hospitals and S teven H aigh, Right First Time Programme Manager. The Sheffield Vision for a 7 Day Service .

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The Sheffield Vision for a 7 Day Service

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  1. Right First Time – Redesigning how we discharge patients 7 days a weekDr Andrew Gibson, Sheffield Teaching Hospitals andSteven Haigh, Right First Time Programme Manager

  2. The Sheffield Vision for a 7 Day Service Any Sheffield citizen’s experience of the health and social care system is a positive one, where their care needs are met at the right pointand delay in accessing care is eliminated. By eliminating delay we will improve the outcome for the individual and make better use of the resources available. This is a whole system challenge

  3. Sheffield in the National Context Common challenges with: • Length of Stay • Increasing rates of emergency admissions • Delayed discharges • High variation between weekday and weekend discharges • Challenges with the costs of long term care THE VARIATION BETWEEN WEEKDAY AND WEEKEND CAPACITY HAS A SIGNIFICANT IMPACT ON EFFICIENCY AND EFFECTIVENESS

  4. The Sheffield Approach • Ambitious Better Care Fund Plan (£280m) • Strong on partnership and relatively stable • Recognition that delays cause harm and that until we get the system flowing we don’t know how big a hospital or community we need IF WE REDUCE AVOIDABLE ADMISSIONS AND MINIMISE DELAYS WITH DISCHARGE THE POTENTIAL RESOURCE SHIFT TO THE COMMUNITY COULD BE EQUIVALENT TO A SIGNIFICANT NUMBER OF BEDS

  5. The Sheffield 7 Day Challenge – the immediate focus ACUTE CLINICAL STANDARDS – baseline assessment showed: 1. Key gaps in workforce - • Junior doctors, nurse practitioners and AHPs • Consultant numbers to assess care needs in 1 hour for the sickest patients 2. Key service issues – • Specialties are all at different levels of readiness

  6. The Sheffield 7 Day Challenge – the immediate focus COMMUNITY STANDARDS – or looking at the system as a whole We see whole system flow (Right Care, at the Right Time, with the Right Person) as being important to quality and safety LEVELLING UP WEEKEND TO WEEKDAY DISCHARGE RATES IS IMPORTANT AS A MEASURE OF FLOW

  7. The Sheffield Challenge – the immediate focus

  8. What have we done? • Switching from assess to discharge to discharge to assess • Built capacity in the community (Active Recovery) to take discharges in 24 hours, 7/7 • Developed the for IC bed model to take transfers in 24 hours, 7/7 • Need to address long term care in the same way

  9. Early D2A Testing Showed

  10. Where are we now? • D2A now established on GSM wards and will rollout to other medical specialties • Active Recovery is down to a 24 hour wait (from a mean of 7 days) • Discharging to off site beds at weekends is better • DTOCs currently down to around 40 (not good but better then 125+ earlier this year)

  11. What’s next for 7 day discharging? COMMUNITY STANDARDS: • Stabilise D2A – making it business as usual • EVALUATION – is it better for patients, is it affordable • Link to the Commissioners plans for the Better Care Fund

  12. What’s next for 7 day discharging? ACUTE STANDARDS • Focus on the 91% that just go home – 1.58:1, weekday to weekends • Identify the key service transformations needed to enable this – ward processes, 7 day senior decision makers (doctors, nurses, therapists etc), transport, TTOs • Move to morning discharging 7 days per week

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