Improving the efficacy of elderly patients' hospital discharge through multi-professional safety briefings and behavioural change

Corrado, Joanna; Topley, Kathryn; Cracknell, Alison

doi:10.1136/bmjquality.u209431.w3871

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…Huddles have been reported as potentially beneficial to MDT communication and teamworking in hospital inpatient wards 30–32. One QIP on a geriatric inpatient ward reported increased speed of discharge summary writing after focused discharge discussions within huddles33 which may support timely discharge. High-quality huddles may reduce LOS24 34 and potentially reduce readmission rates24; however, evidence for this was of low quality 24.…”

Section: Available Knowledgementioning

confidence: 99%

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

Britton

2023

BMJ Open Qual

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BackgroundNHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward.InterventionThirty-minute board rounds were reduced from twice daily (Monday–Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5–10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation.MethodsThis QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process’. Patient discharge data were collated via trust metrics as a balancing measure.ResultsThrough board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75–17.5 confirming no negative impact on patient flow following board round amendments.ConclusionWhile significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.

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Section: Available Knowledgementioning

confidence: 99%

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

Britton

2023

BMJ Open Qual

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“…From a broader perspective, a few earlier studies on hospital discharge have focused on the coordination of professional groups in discharge planning [10][11][12][13][14] and on professionals' perspectives. [15][16][17] These studies concur that effective communication between hospital and community care settings is an important element for quality discharge.…”

Section: Open Accessmentioning

confidence: 99%

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

Jeffery,

Monkhouse,

Bertini

et al. 2023

BMJ Open Qual

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BackgroundDischarge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England.MethodsWe interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights.Results62 specific enablers and blockers to effective D2A practice emerged.DiscussionThese findings supported the development of a comprehensive service improvement toolkit.ConclusionFive recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.

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“…The first study meeting eligibility criteria was published in 2004; 11 the majority (71.5%; N=113) were published between 2014 and 2019. 8,9,21,22,25,27,[30][31][32][34][35][36][37]39,[41][42][43][44][47][48][49]51,53,[56][57][58]62,63,65,[67][68][69][70]72,74,76,77,79,81,83,85,87,89,90,[92][93][94]96,97,[99][100]…”

Section: Year and Location Of Studiesmentioning

confidence: 99%

“…8 % ; N=21). 29,30,34,38,48,51,54,58,66,71,77,81,87,[92][93][94][95]127,131,148,154 Only 2 qualitative studies (less than 2% of all studies) specifically assessed and reported on unintended negative consequences of the huddling practice, including added pressure on staff time and workload, 22 exclusion of clinical trainees, and inadvertent reinforcement of medical hierarchies. 24 We summarize the major findings on huddle team process outcomes in Fig.…”

Section: Effectiveness Of Huddlesmentioning

confidence: 99%

Huddles and their effectiveness at the frontlines of clinical care: a scoping review

et al. 2021

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BACKGROUND: Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS: A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS: Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION: Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION: This scoping review was registered with the Open Science Framework on 18 January 2019 (https://osf.io/bdj2x/).

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Improving the efficacy of elderly patients' hospital discharge through multi-professional safety briefings and behavioural change

Cited by 3 publications

References 3 publications

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

Huddles and their effectiveness at the frontlines of clinical care: a scoping review

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