Optimising pathways to drive improvement in patient care as a Multi-Disciplinary Team
Dom Hurford, Executive Medical Director, Cwm Taf Morgannwg University Health Board
Introduction
Residents of the Cwm Taf Morgannwg University Health Board area face consistent difficulty in receiving timely urgent care, with ambulance handover delays and prolonged waits in A&E departments becoming more frequent. By April 2025, we aim to empower 15 wards to optimise patients for discharge and reduce average hospital stays.
Methods
We developed the 'Optimise' framework to enhance patient care from admission to discharge using tools, models, and digital enablers, as part of the 6 Goals for Urgent and Emergency Care programme.
This initiative, involving health, social care, and third-sector staff, employs Kotter’s change management theory and frequent evaluations to ensure successful implementation.
The framework was tested in unscheduled care wards over four weeks, ensuring its components were effectively implemented and improved patient journeys. This involved regular multidisciplinary board rounds, aligning measures with national quality standards, increasing staff engagement, and emphasising patient-centred care to enhance discharge planning and service delivery.
Measures used
- Expected Discharge Date compliance
- % of patients with recorded discharge pathway
- % of Discharge to Recovery then Assess (D2RA) pathways recorded of total pathways
- % of Red to Green recorded
- Time between admission and Clinically Optimised for Discharge status (avg days)
- Pathway allocated on discharge
Outcomes
- Positive feedback from staff who feel empowered to provide patient-centred care.
- Patients and families reported better-informed discussions and clear care plans.
Significant improvements in the Respiratory Ward:
- Time between admission to discharge reduced from 56.5 to 11.3 days.
- Patients with recorded pathway increased from 27% to 96%.
- D2RA pathways increased from 20% to 74%.
- Average length of stay reduced from 9.1 to 8.2 days.
Learnings
- Initiation of the project should have been longer and wide-spread with more communication, learning platforms, engagement sessions, and workshops to better prepare staff for changes.
- The transformation challenged traditional methods, causing ambiguity and nervousness among staff.
- Increasing staff capability through training is essential for successful spread and scale.
What next?
- Continue mentoring multidisciplinary teams and engaging patients/families
- Organise workshops, engagement sessions, and accredited 'train the trainer' programs·
- Support clinical and operational leads to extend the 'Optimise' framework across specialties, with potential to spread and scale nationally.
Contacts
