Context The improvement project was done in a paediatric tertiary hospital; it was led by a junior doctor and administrative staff officer with involvement of a consultant, junior doctors and nurses.
Problem Trust strategy is to achieve zero harm, no waits, no waste and working together. In addition, the National Clinical Data Standards Assurance Program (2010) has mandated that electronic Discharge Summary (DS) should be sent out from medical teams to the appropriate GP within 24 h of the patient being discharged and the patient should be sent home with one copy of DS in their hands. In 2013, 60% of the Renal Ward discharge summaries were being sent out in time.
Assessment of problem and analysis of its causes We interviewed doctors, nurses and pharmacists to get a better understanding of the process that led to DS being posted to GPs. We identified following factors that led to delays: poor communication within the team and lack of ownership of this task. We held a stakeholder meeting for brain storming and shared ideas to improve the existing process. We developed junior doctor rota describing who is responsible for the DS completion and agreed that the patient’s nurse was responsible for ensuring that patient did not leave without DS.
Intervention The new process for writing DC comprised of a number of steps. On call junior doctor for the week is in charge of getting information from the senior nurse on who will need the DS on a daily basis; the same person is in charge of completing DS, printing it and giving it to the patient’s nurse who was not allowed to discharge patent without a DS. We allocated new place for the storage of GP copies of DS to trigger action from administrative staff to post DS to GPs. We ensured that all team members were aware of the new system by attending handover sessions.
Study design Observational study.
Strategy for change We attended ‘away days’ for all levels of nurses and junior doctors induction and informed them of the new system. We encouraged all team members to approach project leads if they identify new problems as those were to be our new PDSA cycles. We aimed to have >90% DC summaries done timely over a 16 week period. The National standard is 95%.
Measurement of improvement We kept a record of every DS completed. For those not completed a mini root cause analysis was done to investigate the cause of the delay. Data analysed weekly and results shared with all staff.
Effects of changes The effects of changes were better quality of patient care as timely DS done (one of six domains of quality) and improved communication between professionals in tertiary care and GPs. We achieved and sustained >90% target (Figure 1).
Lessons learnt This project taught me the importance of a multidisciplinary approach when planning change. We need a desire and commitment to change and on planning the improvements. It is crucial to see problem through different professionals views as this aids problem analysis. Next time, I would involve a patient or a parent to oversee our work.
Message for others Understanding problem and the process before implementing change is crucial for success. Making sure that all team members are aware of project and evaluating feedback is important for sustainability. This improvement is important for quality of care we provide as it addresses one of six quality care domains. Discuss each failure with the team and perform new PDSA for each problem identified.
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