Next week we are going for green!
Good morning,
The Trust is working together with health and social care partners, KPMG and the Emergency Care Improvement Support Team (ECIST) to take part in a nationally developed initiative called 'Breaking the Cycle Week – Going for Green' which will run from Monday 28 November to Friday 2 December.
In collaboration with partners, we will utilise Patient First methodology to explore new ways of working and areas for improvement related to the patient journey through the emergency care system and beyond.
What do we want to achieve?
Our key aims throughout the week will be to:
- Improve our patient’s experience
- Improve emergency performance
- Ensure every patient has a valuable estimated date of discharge
- Have no stepdown patients in ITU/HDU awaiting beds
- Reduce the number of patients that are medically fit for discharge
- Ensure that every patient understands their care plan
- De-escalate the Admission and Discharge Lounge
- De-escalate the Surgical Assessment Unit
- De-escalate the Same Day Emergency Care Unit (SDEC).
Central to the week will be a visual management system to assist in the identification of wasted time in a patient’s journey; this will be familiar to many as red and green bed days.
We want to turn our red bed days into green ones!
What is a red bed day?
A red bed day is when a patient receives little or no value adding acute care. The following questions should be considered:
- Could the care or interventions the patient is receiving today be delivered in a non-acute setting?
- If I saw this patient in outpatients, would their current ‘physiological status’ require emergency admission?
If the answers are 1. Yes and 2. No, then this is a red bed day.
Examples of what constitutes a red bed day:
- A planned investigation, clinical assessment, procedure or therapy intervention does not occur
- The patient is in receipt of care that does not require an acute hospital bed
- The medical care plan lacks a consultant approved expected dateof discharge
- There are no consultant approved physiological and functionalclinical criteria for discharge in the medical care plan.
A RED day is a day of no value for a patient.
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What is a green bed day?
A green bed day is when:
- A patient receives value adding acute care that progresses their progress towards discharge
- Everything planned or requested gets done
- The patient receives care that can only be in an acute hospital bed.
A GREEN day is a day of value for a patient
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How will the week run?
A clinical control centre (CCC) will be established for the week; colleagues in CCC will collect data and escalate delays for resolution in real time.
Each inpatient ward will be allocated a multi-disciplinary task force to support them during the week.
On Monday 28 November, every patient on our wards will be turned red and reviewed twice daily; from this point our sole aim will be to convert these red bed days to green ones.
The process that will be followed:
- Start the daily, morning multi-disciplinary Board Round with all patients marked as ‘Red’
- The day remains as ‘Red’ if there is inadequate senior presence at the Board Round to allow firm decisions to be made
- The day remains as ‘Red’ if there is no clinically owned expected date of discharge (set assuming ideal recovery and no unnecessary waiting) with clinical criteria for discharge and a clear case management plan
- The Board Round should ensure that a patient’s case management plan is progressed and converts the day to ‘Green’. If a patient requires an investigation that day to progress their care, then the day will only become ‘Green’ if the investigation occurs that day and there is a clear plan of action with regard to the result. If the patient has not met their clinical criteria for discharge and is receiving active interventions to get them to that state by tomorrow, the day is only ‘Green’ if the discharge prescription medications are ready by the evening before the expected date of discharge
- The team must be clear what actions constitute a day being ‘Green’. For example, these do not include observations being undertaken, oral medications, IV antibiotics etc. as these can be delivered out of hospital unless the patient is physiologically unstable
- The constraints identified by wards to converting a red bed day to a green bed day need to be proactively managed at the Board Round. Those that cannot be immediately resolved need an in-day escalation process (we need guidance on reasons for delay to understand what changes could have been made to care to achieve a green bed day for this patient
- The escalation process needs to proactively manage the constraint. Failure to resolve constraints proactively and just ‘report them’ is a non-value adding process
- At the end of the week, the top five constraints that could not be resolved by ward teams or following escalation should be considered by senior operational managers and where appropriate, added to local improvement plans.
How will we measure success?
Our metrics for success are as follows:
- Number of red days
- Number of green days
- Number of estimated dates of discharge at the start of each day
- ED performance (all touch points)
- Ambulance handover delays
- Number of pre-noon discharges by ward
- Number of total discharges by ward
- Number of escalation beds open
- The reasons for a red bed day being captured.
We will be sharing progress against these metrics with you at the end of each day during the Breaking the Cycle Week.
Teams across the Trust have been working hard to prepare for the week and it is fantastic to see the enthusiasm shared by everyone to create a better experience for our patients. We know that this initiative has seen great success in other trusts, and I am confident we that we will see the same levels of success at Medway.
If you have any queries about Breaking the Cycle Week, please contact Alison Heron (alisonheron@nhs.net) or your line manager.
Mandy
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