One in the Bed
15 April 2016 Last updated:
21 April 2021
One in the Bed
Broken Hill Base Hospital ( BHBH ) implemented a streamlined discharge process, a discharge lounge and a Hospital in the Home service, to improve the flow of patients through the emergency department ( ED ).
View a poster from the Centre for Healthcare Redesign graduation, April 2016.
To increase admitted National Emergency Access Target ( NEAT ) performance from 38.8% to 90%, increase discharge times from 25% to 90% and reduce length of stay ( LoS ) of admitted patients by 40%, within 12 months.
- Improves the patient journey from admission to discharge.
- Improves NEAT performance and discharge times.
- Increases hospital revenue by reducing LoS .
- Places the patient in the right service, within an appropriate timeframe.
- Delivers education, information and patient-centred care.
FWLHD has a population of approximately 30,000 people, spread across a distance of almost 195,000 square kilometres. Broken Hill has a population of 18,500, of which 7.5% are Aboriginal. It is the ninth most socially-disadvantaged local government area in NSW , with the median age six years above the Australian average and 20% of the population over 65 years, compared to the national average of 13.2%. The age and demographics of this population suggests that the need for acute healthcare services will significantly increase in the future.
Prior to the project, BHBH was not meeting NSW Health benchmarks, including NEAT performance and LoS . There were poor admission times in the ED , with only 38% of patients transferred to a ward within four hours. Discharge times were also poor, with 75% of patients leaving the facility after the standard discharge time of 11am and 42% of those leaving after 4pm. These delays reduced access to available beds for acutely ill patients from the ED and increased the risk of negative patient outcomes and experience.
It was also identified that the ED was treating patients who were discharged from the acute care setting, as they were no longer ill enough to require a hospital bed. However, they still required intravenous antibiotics up to three times a day. The ED was experiencing up to 12 occasions of service per day, where the patient required up to 40 minutes of face-to-face time with a nurse. This time was equal to one full-time registered nurse per week.
- Doctor’s round sheets were printed and ordered according to estimated date of discharge, to increase the efficiency of morning rounds and provide an organised discharge process.
- The Agency for Clinical Innovation sunflower tool was modified to communicate the estimated date of discharge to patients, with a sign that said ‘I’m going home on...’. Sunflowers were used in all patient rooms and updated daily by ward clerks and nursing staff, following updates to the journey board.
- Electronic medical records were modified to incorporate discharge planner referrals for complex patients.
- A Hospital in the Home service was implemented, to expedite treatment time and improve the patient experience. This involved delivering care in a comfortable, patient-friendly environment in the hospital or in the patient’s home, rather than the ED .
- A discharge lounge was implemented, to streamline the discharge process by moving patients out of the acute ward and into a comfortable lounge area before 11am. This increased access to beds and provided the patient with a comfortable place to wait for friends, family or carers to take them home.
Implementation - the initiative is ready for implementation or is currently being implemented, piloted or tested.
- April 2015 to September 2016
- Broken Hill Base Hospital, FWLHD
Evaluation and results
- A full evaluation will take place in September 2016, which will include the following measures:
- admitted emergency treatment performance
- patient satisfaction surveys
- number of discharged patients by 11am
- number of admissions to the Hospital in the Home service.
- Early results show the number of patients discharged by 11am increased from 25% in April 2015 to 81% in February 2016, following implementation of the project.
- Emergency treatment performance increased from 33% to 66% within four weeks of implementation.
- Patient feedback has been very positive, with no negative survey results to date.
- Discharge times increased from 25% to 81% within the first four weeks of implementation.
- LoS has showed minimal improvement to date, but should improve with continued development of the Hospital in the Home service.
- It is hoped the Hospital in the Home service will soon be expanded to include referrals from general practitioners, allowing patients to bypass the ED .
- The methodology learned in the Centre for Healthcare Redesign Program was useful for keeping the project on track, particularly through challenging times.
- Structural changes within the team meant the project had to be re-sold to gain engagement and buy-in from senior management.
- Staff on the floor were very supportive, including front-line nursing staff, personal care assistants and porters.
- NHS. Discharge Lounge Operational Guidelines
- NSW Health. NSW Hospital in the Home (HITH) Guideline GL2013_006
Patient Flow Manager and Discharge Planner
Broken Hill Base Hospital
Far West Local Health District
Phone: 08 8080 1453 / 0419 839 069
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