Nid yw'r tudalen hwn ar gael yn Gymraeg ar hyn o bryd. Dyma'r fersiwn Saesneg.
Early Safe Discharge
This step requires Health and social service partners to agree and implement processes which facilitate early safe discharge following unscheduled admissions. The intended outcome is that patients have an appropriate length of stay and are discharged in a planned co-ordinated way with suitable support services.
Flow (Acute and Community Hospital Services)
Clinical reflection on the impact of the Emergency Department (ED) Access targets has been mixed. While there is a desire to ensure that benefits to Front Door flow, clinical effectiveness and patient experience are not lost, it is felt that increased attention needs to be paid to the timely hand-over of patients and treatment plans from ED and Clinical Decision Units.
The presences of senior clinical decision makers matched to demand, is a key process measure. Local process measures will need to reflect local capacity and demand matching.
The nature of core, ward-based clinical activity has shifted due to an ageing patient population, with increasingly complex, mixed health and social care needs. As anyone working in the service knows, this is no longer limited to the realm of specialist Care of the Elderly wards. Therefore, workforce plans, training and the focus of daily ward activity need to shift in order to reflect this. Systems need to be in place that both facilitate delegated discharge by the appropriate member of the team (often nursing) and are respectful of the wishes of patients to be discharged at reasonable risk (after appropriate discussion, capability and consent safety nets). It is sometimes unnecessarily difficult for an insightful, capable older patient with complex needs to achieve discharge at acceptable risk while awaiting additional input to reduce those risks further.
Critical to Flow, is the presence of Community Response Teams / Intermediate Care Service senior decision makers, removing inter- and intra-organisational barriers and applying Pull into community services. As the patient crosses the Hospital/ Community interface risks increase again and the rapid transfer of accurate information (including the treatment plan) to the receiving Primary/ Community services, with appropriate confirmatory feedback signals, are no less important for both quality, and to reduce unnecessary re-admission.