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Background Wirral University Teaching Hospitals NHS FT serves a population of 330,000. Patients who subsequently die in hospital spend 21 days (mean) of their last 100 days of life in hospital. When time is so precious, it is crucial that every day spent in hospital 9counts9. Inpatient specialist palliative care and end of life care provisions was fragmented. The aim was to improve care and cohesiveness by putting patient9s wishes at the centre of clinical process. Methods The 9red to green days9 concept (developed for Safer Patient Flow) was adapted to focus on patient experience of care. At the start of the day a board round assesses 9what matters most today9 for each patient, with agreed actions across the team. The patient9s day starts as silver and is then recorded as 9gold9 only if progress is made against the patient9s expressed wishes. A silver day means a patient receives high quality care, but no action to achieve wishes. The team applied 9Plan Do Study Act9 methods to develop this approach from concept to practice. Results Patients9 wishes were more consistently understood and met. Examples include: obtaining a wig, a urinary catheter, complex spiritual care, wedding ceremony, rapid discharge, hospice bed, physical symptom control. The focus on 9what matters most9 to patients increased team cohesiveness, greater peer support and shared responsibility rather than individual caseloads. Performance was monitored using Statistical Process Control and ongoing analysis of barriers to achieving a gold day. There is an association between patient flow and the ability of the SPC team to meet patient wishes. Conclusions A singe focus on patients9 wishes and what matters to them helps team working together to meeting these goals. Collecting evidence on why patients are unable to achieve their wishes supports thematic learning to guide future commissioning and service developments. |
