Introduction High numbers of clinically optimised patients in a DGH were having daily clinical input. RAAC clinical incident resulted in movement of clinically optimised patients from the district general hospital to a community hospital increasing the community bedbase from 32 to 72. This gave the opportunity to review how these patients were managed. Method In the first PDSA cycle, it was recognised that daily medical ward rounds for clinically optimised patients were neither necessary nor optimal and potentially perpetuated the impression that patients required in hospital care. These observations were sought using process mapping and fish bone diagram. In the second cycle, all clinically optimised were planned to be seen once a week on ward round. All patients were discussed on the daily multidisciplinary board round and if needed were changed on the board to not clinically optimised which prompted review. Nurses could also ask for review outside of the board round. Results During a four-week period one third, (24/72) of patients needed review outside of the weekly planned review. Of these 79.2% required only one review. Consequentially junior doctors reported to save an estimated cumulative of 16–48 hrs per week. Balancing measures of falls, mortality, pressure sores and complaints showed no change in the four months after implementation of the change. Patient, family and staff qualitative feedback was gathered. The next two cycles involved polypharmacy review and offered clinically optimised patients a ‘What Matters to Me’; meeting with their family utilising the time saved to improve communication, medication review and future care planning. Conclusion Data suggested no adverse impact of change in practice. Staff were redeployed to the front door frailty team rather than community hospital to improve access to Comprehensive Geriatric Assessment, and a new pathway was designed to create uniformity in flow for admissions to frailty.

中文翻译：

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2278 通过临床优化的路径方法为患者体验增加价值


简介 DGH 中临床优化的患者数量众多，每天都有临床输入。RAAC 临床事故导致临床优化的患者从地区综合医院转移到社区医院，将社区床位从 32 个增加到 72 个。这为审查这些患者的管理方式提供了机会。方法 在第一个 PDSA 周期中，人们认识到临床优化患者的每日内科查房既不必要也不是最佳选择，并且可能会使患者需要医院护理的印象永久化。使用过程映射和鱼骨图寻找这些观察结果。在第二个周期中，所有临床优化的病例都计划每周查房一次。所有患者都在每日多学科委员会轮次中进行讨论，如果需要，在董事会上将其更改为未进行临床优化，这促使了审查。护士也可以要求在董事会轮次之外进行审查。结果 在 4 周期间，三分之一 （24/72） 的患者需要在每周计划复查之外进行复查。其中 79.2% 只需要一次审查。因此，初级医生报告称每周估计累计节省 16-48 小时。跌倒、死亡率、压疮和投诉的平衡测量显示，在实施更改后的四个月中没有变化。收集了患者、家属和工作人员的定性反馈。接下来的两个周期涉及多药治疗审查，并为临床优化的患者提供“什么对我很重要”;利用节省下来的时间与家人会面，以改善沟通、药物审查和未来的护理计划。结论 数据表明实践中没有变化的不利影响。 工作人员被重新部署到前门衰弱团队而不是社区医院，以改善获得综合老年病评估的机会，并设计了一条新途径，为衰弱入院创造统一流程。