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  • Maintain communication channels with community health and social care so you’re able to safely manage more patients at the scene and can refer them on to appropriate services.
  • Explain to patients and their loved ones that you and the wider healthcare team will do all you can to get them home without delay.
  • Provide an accurate handover including the patient’s current home situation and functional ability. If therapy teams receive a handover at the front door of the emergency department, they are more able to carry out an effective initial assessment, especially in the case of frail patients.

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Conduct senior reviews for all patients before midday.
  • Ensure all patients have a clearly documented plan in their medical notes that includes an expected date of discharge and clinical criteria for discharge (including functional and physiological parameters).
  • Ensure that patients and their family can answer the four questions (listed below) and are informed of their care plan.
  • Make sure that you’ve asked patients what matters to them and explain the risk of a long hospital stay versus returning home or a non-acute setting.
  • Think “why not home today?” every day.
  • Ask why patients are still in bed and include the need for patient mobility (get up, get dressed and moving #EndPJparalysis) in medical notes.

Four questions for patient progress:

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what is the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Clearly communicate the risks of unnecessary long stays to staff.
  • Ensure all patients have a clearly documented plan in their medical notes that includes an expected date of discharge and clinical criteria for discharge (including functional and physiological parameters).
  • Make sure teams are communicating the four questions (listed below) to patients and their families.
  • Identify the top 3 reasons that cause unnecessary patient waiting in your hospital and make them the focus of improvement efforts.
  • Create positive learning loops using a continuous improvement approach. Use collective knowledge to problem solve and creative innovative solutions and celebrate successes.
  • Use outcome, process and balancing measures and ensure they are visible to all so team members can see that improvement efforts are having a positive effect.

Four questions for patient progress:

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help your team ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what is the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Make reducing unnecessary patient waiting a priority.
  • Ensure all patients can answer the four questions listed below and that they know their plan.
  • Think “why not home today?” every day. Challenge if a person really needs to be in hospital for the treatment they require.
  • Check all patients have a clearly documented plan in the medical notes that includes an expected date, and clinical requirements, for discharge.
  • Make a “knowing how we’re doing” board for your ward/department to record key metrics (including the number of long stay patients).
  • Encourage all patients to get up, dressed and moving. Don’t automatically refer them onwards for physiotherapy or occupational therapy. Ask loved ones to support you in this.

Four questions for patient progress:

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what are the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Empower patients to manage their own medicines while in hospital.
  • Prepare medicines for discharge as soon as patients are admitted (or even earlier if elective).
  • Work closely with ward staff to understand the expected date of discharge and anticipate any medicinal requirements that may impact on this.
  • Communicate with care providers & community pharmacists to help prevent readmission due to medicine issues.
  • Prescribe TTO to reduce TTO processing time.
  • Make the pharmacy team aware of all patients with blister packs and try to minimise last minute changes to medicines in this group

Four questions for patient progress

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what are the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Champion what matters to the patient.
  • Challenge decisions about long term care happening in hospital as opposed to at home or in a non-acute care setting.
  • Remind the team that patients should be at home when possible

Four questions for patient progress:

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what are the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Increase move therapy when patients are admitted so they can be immediately assessed and complete a comprehensive geriatric assessment for frail patients.
  • Ask “why not home today?” every day.
  • Give permission to all members of the team to get patients up, dressed and moving #EndPJparalysis.
  • Review patient demand and match it to therapy staffing capacity.
  • Explain the risks of long-term hospital stays versus going back to their normal residence, non-acute care setting, to patients.
  • Ask the patient what matters to them, gain information from paramedics and carers and family too. Make sure this information is stays with the patient throughout their hospital journey.
  • Maximise staffing resource by avoiding duplication between occupational therapists and physiotherapists.
  • Describe patient needs rather than prescribe definitive solutions for long term care. Avoid the use of the term ‘back to baseline’.
  • Where possible, assess patients in their place of residence (discharge to assess).

Four questions for patient progress:

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what are the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

  • Be the guardian of what matters to your patient, positively challenging other health care professionals to reduce patient waiting.
  • Attend system meetings and help the system think differently by offering an objective point of view.
  • Bring simple language to conversations and challenge acronyms and words that patients won’t understand.
  • Support and encourage patients and their families to ask about, and understand, the four questions listed below.

Four questions for patient progress

The Clinical Criteria for Discharge (CCD) is the minimum physiological, therapeutic and functional status a patient needs to achieve before discharge. Use these four questions to help ensure that each patient’s plan is tailored to their needs.

  1. What is the matter with the patient (or what are we trying to exclude)?
  2. What have we agreed we are going to do to help the patient’s recovery – this morning, this afternoon, this evening?
  3. What needs to be achieved to get the patient out of hospital (i.e. what is the CCD)?
  4. What is the expected date of discharge?

For practical advice on improving patient flow and providing the best outcomes for your patient, visit www.nhs.uk/thinkpatientprogress.

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