Delay in completing discharge letters in Mental Health

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Delay in completing discharge letters in Mental Health Services

Delay in completing discharge letters in Mental Health Services

Aim of the project • Reduce delay in producing discharge letters. • SIGN recommends

Aim of the project • Reduce delay in producing discharge letters. • SIGN recommends 1 week (2 weeks if complex or waiting for results) • Communication with GP & CMHTs • Performance was poor in some areas with delays of several weeks. • Objective would be to have an average of 7 days with 100% completed within 14 days.

Process – what we did • Process map • Minimising delays / steps in

Process – what we did • Process map • Minimising delays / steps in process • Baseline data (secondary outcomes) – Time to dictation – Time to typing – Time to verification

Improvements • Clinical Administration Guidance for Medics – clear expectations for medical / admin

Improvements • Clinical Administration Guidance for Medics – clear expectations for medical / admin • Electronic inpatient records – Juniors no longer waiting days for notes to arrive • Development of electronic assessment proforma – Information available electronically and can be updated during admission and be ready for discharge. • Digital dictation and purchase of equipment – Juniors can dictate and upload at any site • New Hospital - ? impact

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Weeks 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Run chart - dimensions • Vertical Axis is mean days to complete discharge letter

Run chart - dimensions • Vertical Axis is mean days to complete discharge letter from Jan 2014 – April 2015 • Horizontal Axis is months • Data line is in black • Median line is marked in blue

Days to discharge letter Jan 2014 – April 2015 20 New Hospital Opens 18

Days to discharge letter Jan 2014 – April 2015 20 New Hospital Opens 18 16 14 Days 12 10 Development of Clinical Administration Guidance 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Weeks 17 18 19 20 21 22 23 24 25 26 27 28 29 30

GEE • Overall there has been no significant shift in the median • There

GEE • Overall there has been no significant shift in the median • There was an early trend for a reduction which coincides with producing and circulating a clinical administration guidance for medical staff. • Identify reasons for later shifts and reason for outlying bad months – ? due to individuals or systems

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Weeks 17 18 19 20 21 22 23 24 25 26 27 28 29 30

GEE • Overall there has been no significant shift in the median. • There

GEE • Overall there has been no significant shift in the median. • There was an early trend for a reduction which coincides with development of a clinical administration guidance for medical staff. • There was sustained improvement last year and later negative trend may have been an effect of moving to the new Hospital.

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days

Days to discharge letter Jan 2014 – April 2015 20 18 16 14 Days 12 10 8 Development in 2014 of Clinical Administration Guidance by working group of medical and 6 4 Reason for poor performance in May 2015 unclear 2 0 1 2 3 4 5 6 7 Deterioration (trend) after sustained improvement (shift) may be due to move to new Hospital in April/May 2016 8 9 10 11 12 13 14 15 16 Weeks 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Next steps ge. E • Complete PDSA on secondary outcomes – dictation, typing, verification.

Next steps ge. E • Complete PDSA on secondary outcomes – dictation, typing, verification. • PDSA – Updating admission clerking during time on ward so that it is ready for discharge.

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Completing Letters of Recommendations in Naviance Completing LettersCompleting Letters of Recommendations in Naviance Completing Letters
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COVER LETTERS THANK YOU LETTERS COVER LETTERS MAINCOVER LETTERS THANK YOU LETTERS COVER LETTERS MAIN
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