The Admitted Patient Specialty Ward

1. The Admitted PatientSpecialty Ward Dr Alistair Dorward Consultant Respiratory Physician Royal Alexandra Hospital Paisley

2. Surgery Acute Admissions

4. Patient Flow Acute Admissions Home Home

5. Specialty Wards • Chronic/complex patients seen by appropriate specialist Hanlon, Beck, Robertson, Henderson, Capewell, Dorward . Coping with the Inexorable Rise in Medical Admissions: Evaluating a Radical Reorganisation of Acute Medical care in a Scottish District Hospital. Health Bulletin 55 (3) 1997

6. Speciality Ward Flow

7. Barriers to Patient Flow • Medical • Unwell • Dying • Symptom control • Requiring O2 • Poor mobility • Medical Administration • Waiting ward round • Waiting consultant • Waiting specialist / Geriatrician opinion • Waiting • Social work • AHP • Transport • Long term care • Other waits • Radiology • Endoscopy • Bronchoscopy • Pulmonary function • Transport • Other investigations • Refusing home • Patient   • Relatives • Patient Boarding

8. RAH Respiratory Unit 39 beds – 1 empty

9. RAH Respiratory Unit • 19 male • 1 day case • 1 elective admission

10. RAH Respiratory Unit

11. COPD Current discharge procedures in UK hospitals • Only 53% of patients were seen by a respiratory physician before discharge;: 69% were seen by a specialist nurse • Only 32% of hospitals use a formal discharge check list • Only 22% of hospitals have a COPD discharge pack for Patients • Only 25% felt ready to leave hospital • Only 26% felt able to cope at home • Only 37% felt reassured that good support was available at home • Only 34% felt informed about their COPD and reasons for admission • Only 52% of hospitals refer patients directly to pulmonary • rehabilitation • Only 63% of hospitals refer patients to their smoking cessation • service

12. Bed occupancy by illness