During daily board and ward rounds, all patients’ physical and mental health status, medication needs, functional ability, and nutrition and hydration status should be reviewed, and the information shared with the multidisciplinary team.
Patients whose length of stay (LOS) is seven days or more need to have a weekly review involving multidisciplinary team members visiting wards. You should be aiming to:
- Review the patient’s functional and physiological status
- Identify a plan for the patient including a discussion around all possible discharge options
- Establish what the patient is waiting for
- Work out how any constraints or barriers can be removed.
The outcomes of the multidisciplinary meeting should be shared with patients and their families or carers.
There should be an effective escalation process to ensure constraints causing unnecessary patient waiting are removed.
The systematic use of weekly long-stay patient reviews can reduce the number of in-patients with a LOS exceeding 20 days by up to 50%.
These reviews introduce supportive challenge and help ward multidisciplinary teams tackle obstacles that are delaying the treatment and discharge of patients who have been in hospital for a prolonged period.
The review should be carried out on the ward and be led by a senior member of staff. Reviews should capture both qualitative and quantitative information on the reasons for the wait, with a report compiled from all the material gathered. They should aim to identify:
- Why patients are in hospital for seven days or more
- Recurring themes (and where possible, patient characteristics) so patient groups can be identified earlier in the future, and the chance of an extended stay is reduced
- Areas of good practice
- Areas with the opportunity for improvement
The outcomes from the report should be used to ensure that lessons learnt or questions still to be answered can be built into internal actions and local system action plans.
We need to identify the reasons behind stays of seven days or more and the actions which can be taken to avoid delays. By doing so, we can help significantly reduce deconditioning and second and third phase illnesses.