The Admitted PatientSpecialty Ward

Dr Alistair DorwardConsultant Respiratory Physician

Royal Alexandra HospitalPaisley

A C U TE M E D IC IN E

A cu teG en era l

W ard

A cu teG en era l

W ard

A cu teG en era l

W ard

A cu teG en era l

W ard

A cu teG en era l

W ard

C C U

Acute Admissions

Surgery

Patient Flow

Acute Admissions

Home

Home

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

Before After

Cardiology 34% 58%

Respiratory 53% 67%

Asthma 44% 93%

Specialty Wards

Speciality Ward Flow

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

RAH Respiratory Unit

39 beds – 1 empty

RAH Respiratory Unit

• 19 male• 1 day case• 1 elective admission

RAH Respiratory Unit

COPDCurrent 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

Bed occupancy by illness

01020304050607080

Jan-98Jan-00