VOL: 100, ISSUE: 44, PAGE NO: 34
Alexandra Gallagher, RGN
Debi Lynch, RGN; both discharge facilitators, Lister Hospital, East and North Hertfordshire NHS Trust
This article focuses on the impact that establishing a regular multidisciplinary meeting has on the patient journey.
- This article has been double-blind peer-reviewed.
- Download a print-friendly PDF file of this article here
This article focuses on the impact that establishing a regular multidisciplinary meeting has on the patient journey and length of stay at a medical admissions unit. Teamwork is essential if health and social care are to be of the highest quality and efficiency (Borrill et al, 2000).
Patient discharge has been identified as one of the areas where multidisciplinary teams can make a significant difference to the speed and quality of the patient’s journey (Department of Health, 2003a).
Discharge facilitators at Lister Hospital hoped that introducing multidisciplinary team meetings to a medical admissions unit would encourage decisions about patient care to be made more promptly leading to shortened hospital stays.
Introducing multidisciplinary working
All practitioners working on the unit met to discuss the feasibility of this proposal. After discussion it was decided to start the multidisciplinary meeting on the medical admissions unit for a one-month trial. The aim of the trial was to test the effectiveness of a multidisciplinary team meeting and to assess the impact that meetings would have on decision-making and the patient journey.
The multidisciplinary meeting was scheduled to take place each weekday morning after the medical ward round. A suitable venue for a group of 10 people to meet was found on the unit. It was decided that the medical team would present and discuss their plan of care at the meeting. The members of the multidisciplinary team would be able to influence the decisions and advise regarding further interventions (Pearson, 2003).
Following the multidisciplinary discussion, the patient’s journey would be planned by all members of the team including the patient and her or his family. A plan of action would be set including an expected date of discharge. The plan of action could be followed even if the patient was transferred to another ward.
The impact of the multidisciplinary meeting was immediately apparent. Bringing together and focusing the minds of staff in medical, nursing, therapy, pharmacy, intermediate care, bed management and social work was effective. The number of discharges increased dramatically compared with the same period in 2003 - in some months by more than 75 per cent (Fig 1).
As well as the impact on the number of discharges, closer scrutiny also demonstrated a change in the pattern of discharge from the medical admissions unit. Traditionally few patients were discharged at the weekends and during the first half of the week. Discharge of patients at these times increased as the trial continued. Discharges now occur seven days a week. Daily discharges also increased by an average of 100 per cent, from four to eight discharges.
Medical patients in surgical beds
Increases in discharges from the medical admissions unit have meant an increase in available medical and elderly care beds. As a result there has been a reduction in the number of medical patients placed in surgical beds. The number of medical patients occupying surgical beds gradually declined over the trial period to a lower level than has been seen for many years.
In the first month of the trial, February 2004, there was a 62.5 per cent decrease in medical patients being cared for in surgical beds. This was followed by a 33 per cent decrease in March and a 49.5 per cent decrease in April (Figs 2-3).
The trial continued for six months during which time the unit moved from a position of requiring the use of an additional 20-80 medical beds at the Lister site to requiring 0-20 additional medical beds. The change has produced a more than 100 per cent reduction in the mean medical patient occupancy of surgical beds.
This change has allowed bed managers to find beds for patients booked in for elective surgery. Delays in finding beds in the medical admissions unit for A&E patients has also decreased. In fact, the medical assessment unit has started some days with empty beds.
Although many people felt that the improvement was due to a reduction in medical admissions, it has been established that the admission rate has been similar if not higher than in the previous year.
At the end of the trial the group devised a number of recommendations:
- The partner hospital within the trust should adopt the same model following the report from all of the specialties involved;
- The multidisciplinary meeting should be continued;
- The use of a discharge plan, including an estimated date of discharge, was advocated to give structure to the meetings;
- This discharge plan should accompany patients if they are transferred to other wards;
- Patients who require a 48-hour hospital stay are to be kept on the medical admissions unit to ensure continuity. It was found that the inpatient stay increases by 24 hours if patients are transferred;
- Specific criteria for physiotherapy referrals should be drawn up to prevent inappropriate referrals once patients have moved from the medical admissions unit;
- The role of a diagnostic assistant on the medical admissions unit should be developed to reduce delays caused by waits for phlebotomy staff;
- Further work is needed to analyse failed discharge and readmission rates.
The introduction of multidisciplinary meetings has im- proved communication between all members of the team. This has reduced delays for patients on the medical admissions unit to a minimum and produced a more appropriately structured inpatient stay.
All staff feel empowered to contribute to the discussion and influence decisions and plans. This has ensured continued involvement and a commitment to attend. This simple change has created a culture of teamwork. There is a need to challenge long-held beliefs in health care, if we are to foster multiprofessional working (McPherson et al, 2001).
The results showed a significant improvement in decision-making with a rise in discharges from medical admissions unit compared with the same period in 2003.
Multidisciplinary teams can make a difference in identifying an estimated discharge date and length of stay on admissions (DoH, 2003b).
The increases in discharges from the unit have also seen a reduction in the numbers of medical patients in surgical beds, enabling surgical work to continue and medical nurses to care for medical patients.
Following the review all members of the multidisciplinary team felt that the trial should end and the multidisciplinary meeting should become an established part of the medical admissions unit practice.
Understand the importance of good team communication
- Identify the possible benefits for both staff and patients of having multidisciplinary meetings
- Gain a clearer understanding of teamworking in your practice area
Each week Nursing Times publishes a guided reflection article to help you with your CPD. After reading the article use the following points to help you write your reflection:
- Outline the area in which you work and explain why you read this article;
- Describe the last team meeting that you were involved in, outlining the ways in which it was effective and/or ineffective;
- Identify the factors that this article has taught you about the potential benefits of effective meetings;
- Write about how you will use this information to improve team meetings in your particular area of practice.
- What will you do to follow up on the things you have learnt.
For related articles on this subject and links to relevant websites see www.nursingtimes.net