Great geriatric care
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Discovering great geriatric care Version 3 13 August 2014 Tom Downes Consultant Geriatrician Clinical Lead for Quality Improvement, Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 28 th September 2016
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Transcript of Great geriatric care
Discovering great geriatric care
Version 3 13 August 2014
Tom DownesConsultant GeriatricianClinical Lead for Quality Improvement, Sheffield Teaching HospitalsThe Health Foundation / IHI Quality Improvement Fellow28th September 2016
GREAT CARE IS DISCOVERED, NOT DECIDED
Steve Spear, MIT
Sheffield:• Population of 580k and
growing• Europe’s greenest city• 43% of households
vulnerable to significant financial stress
• Single vertically integrated adult provider
• Single Social Care provider• Single Care Commissioning
Group
Sheffield Teaching Hospitals:• One of largest FTs in
England - £1bn turnover and 16k staff
• Large tertiary provider – around one-third of activity
Funding constraints:
George
A complex system problem
2003 Toyota Corolla
The Big Room (Oobeya)
The Big Room in Action
Physiotherapist gives an account of the test of change to get a patient home on the day theywere discharged by the GSM consultant
Senior registrar
General ManagerFor Medicine
GSMMatron
ServiceImprovement
Social ServicesManager
CommunityServicesmanagerPhysiotherapist
Secretary
DischargeLiaison
Let me introduce ‘George’
•82 years old•Lives independently and wants to continue doing so•Widowed 5 years ago•Has mild dementia•Daughter lives locally•Losing weight + poor mobility
PDSA tests of moving from ‘post take’ to ‘on take’
Frailty Unit
Outcome measure: 34% increase in discharge within 1 day
Frailty Unit
opens
Length of stay for frailty unit patients reduced by more than 4
days
Frailty Unit
opens
In-hospital mortality dropped by over 13%
Frailty Unit
opens
Discharge to Assess (D2A)
D2A starts
Reduction of 6 days waiting on
implementing D2A
D2A starts
Sustained 30% reduction of LoS
D2A starts
30% reduction of inpatient falls on pilot
ward
In last one year >10,000 patients discharged to
home support in 1.2 days compared with 5.5 days
Whole system reduction in LoS of patients aged >65y
“It’s changed the way we think.”
Future
• Frailty Unit is continuing to discover improved process and hitting highest ever discharge rate
• Purpose designed Frailty Unit opens 2017 to enhance efficiency and care experience
• Big Room is currently testing D2A for more complex patients
How do we get better at making patients better?
Discovery.
