Problem: Improving patient flow and patient experience, reducing Average Length of Stay and readmissions to hospital are key policy and service objectives of the HSE, the National Acute Medicine Programme, and the Department of Health. Criteria Led Discharge (CLD) is an interdisciplinary tool to support patient engagement in care planning and to support planned discharge from hospital by competent members of the interdisciplinary team without consultant review on day of discharge. The tool is a documented plan identifying the agreed milestones and criteria a patient must meet in order for discharge by planned date of discharge to be effected by a member of the multidisciplinary team.

Improvement Centre (QPIC) was established to oversee a sustainable theatre quality improvement programme.Building on the learning from the experience of introducing The Productive Operating Theatre (TPOT) in Ireland, TQIP aims to support hospitals and multidisciplinary perioperative teams who are committed to quality and process improvement to deliver sustainable improvements in: patient experience and outcomes; safety, quality & reliability of care; improved team effectiveness and staff wellbeing; value and improved efficiency; organisational Quality Improvement (QI) capability, enabling a culture of continuous improvement.Implementation of the programme at scale will improve patient flow and value for money through improved theatre efficiency (e.g. reduction in delays in start times, improved utilisation, reduced over runs and inventory costs), increased capability in the application of quality improvement tools with perioperative teams in the selected sites and increased uptake in other hospitals through demonstrated improvements in waiting lists and performance metrics. Furthermore a central repository and QI knowledge sharing network for perioperative teams will be developed including HSE Perioperative Teams certified in QI methodologies following an accredited programme.The Programme Governance and team have been established and agreement reached on a programme plan. The programme includes a QI training programme for perioperative teams in selected sites and on-going support from the QPIC Quality Improvement Advisors and Nurse Leads. Site selection is based on agreed readiness assessment criteria. Outcome measures will be specific to projects in sites but a target of 10% theatre efficiency improvement is expected by the end of year 1. Two sites, one of which has already begun introducing TPOT, and a new site have been identified as pioneers for the new programme. Specific projects in

Programme for Patient Flow and is closely aligned with the work of the Special Delivery Unit (SDU).To support planning and delivery of the programme, the HSE engaged[1] a technical partner, GE Healthcare Finnamore, with expertise and experience in application of operations management techniques such as lean, simulation and modelling, implementation of evidence based best practice and change management methodologies to improve patient flow.A key outcome is building capacity and capability within the HSE to enable national implementation. The 3 year programme combines hands on change management support, implementation of evidence based best practice in patient flow supported by state of the art data, simulation and analytical techniques and skills transfer to HSE staff at local and national levels to ensure sustainability. Techniques such as capacity and demand and workforce modelling are being applied to support changes in clinical models and processes to deliver improvements in patient flow in 2 demonstrator sites over an 18 month timeline, with subsequent national roll out over a further 18 month period. While the initial focus of this work is in the acute hospital systems in University Hospital Limerick and Galway University Hospitals, the importance of understanding whole system patient flow and interdependencies across acute, primary and community health and social care settings is acknowledged.Initial tests of change are underway in both proof of concept sites, covering such areas as ED flow, bed turnaround, improving flow in medical pathways, frail older persons services, bed management and emergency theatre and surgical assessment areas. Results are anticipated in the following 6-12 months.[1] through a competitive tender process