A nurse-led medically fit for discharge ward for patients unable to leave hospital due to a lack of community places has been shortlisted for a Nursing Standard Nurse Award.
Maddie Groves (seated) and the iCare team. Picture credit: Chris Balcombe
The iCare team at Yeovil District Hospital NHS Foundation Trust is a finalist in the NHS England Enhancing the Experience of Care Award and will find out if they have won at a ceremony in the Savoy Hotel in London on May 1.
Due to increased demand and the lack of capacity in the community to care for the elderly, an increasing number of patients who were fit for discharge were still in hospital. The trust was seeing more patients overall and more patients with complex needs but there were not enough places to send them once they've been treated.
There were large numbers of medically fit patients in every ward. When these patients were on an acute ward with the seriously ill, they inevitably received less attention from staff, delaying and compromising their rehabilitation and further preventing timely discharge. The hospital leadership was pressing for more timely discharges while nurses were highlighting their increasing workloads and the difficulty in ensuring all their patients were getting the right care.
Associate director of nursing Maddie Groves suggested to senior colleague that they cohort medically fit for discharge (MFFD) patients into a nurse-led environment so that resources could be focused on rehabilitation and on preparation for timely and appropriate discharge.
She explains: ‘These patients should not be in our care but they are – and they were being forgotten. We wanted to create a ward in which their care became a priority – where they were offered extensive rehabilitation before safe and appropriate discharge to an appropriate setting. What we do is truly holistic nursing but that is difficult to do on a busy acute ward.’
She approached relevant staff about secondments to the ward and discussed the idea with a wide range of colleagues, including physiotherapy, occupational therapy, dementia care, social services and pharmacy.
A 30-bed ward was designated for the initiative and as many patients as possible relocated. A multidisciplinary team was assembled from throughout the hospital and a protocol developed to define who would be transferred and how they would be managed on their arrival. A transfer process was then established and a patient information leaflet explaining the ward’s focus produced.
‘The ethos of the ward is to have a multidisciplinary approach that ensures that all patients have a safe discharge home,’ explains ward sister Alison Dowd. ‘It is totally nurse led with no routine visits from medical staff, but they are easily contactable if required. Patients have to have completed their episode of acute care and require no further medical input. Their only care needs should be nursing or therapy input.’
‘Ward teams are much slicker at managing discharge for those that have had the rehabilitation they need,’ says Maddie. The team gets together to start or agree discharge planning and continuing rehabilitation places when the patient is transferred to the ward. The senior nurse walks the ward every day to help expedite discharges.
This has yielded significant successes. ‘In the first three months the average length of stay fell from 14 to 11 days despite the winter pressure, and that has now fallen by another two days,’ says Maddie. ‘And in some cases patients have continued their rehabilitation while waiting for their care home and we have in fact discharged them back to their home. ’
Fewer patients need rehabilitation at community hospitals. In an evaluation in November, 98% of patients said they had been treated with respect and dignity.
The MFFD ward not only offers its patients intensive rehabilitation, but also a wide range of therapeutic activities. And the close working with other healthcare professionals has given opportunities to share skills.
Maddie adds: 'Being shortlisted for the awards is a huge honour not only for myself, but for the ward team and organisation as a whole. It cannot be under estimated the “feel good” feeling it gives everyone and the pride we feel in being recognised for delivering excellent patient care.'
Director of nursing and clinical governance Helen Ryan says she is ‘extremely proud’ of the team.
She adds: ‘This small, dedicated team has transformed the discharge process for our patients. It was done at short notice during the height of the winter pressures and with little time available to plan. However, Ali and the team took the initiative, using their experience and sound judgment to create a positive, patient-centred care environment.
‘Everyone who has visited this ward has been impressed with the team and how they are working with therapy and social care colleagues to ensure patients are discharge quickly and safely to the most appropriate destination.’
Patients also rate their care highly – something picked up by the Nurse Awards judges. NHS England Experience of Care Professional Lead Paul Jebb praised the use of patient feedback to improve care still further. ‘It is creative to have done this in an acute hospital and the feedback from patients speaks for itself.’