How it started – home for Christmas
Back in December 2016 we launched a Home for Christmas event with a primary focus on medical wards.
The aim of the week was to introduce the concept of #Red2Green bed days. As you may know by now, red days are days in which patients’ care is not progressed through any positive interventions, whilst a green day is one in which actions occur that proactively progress patient care. The key message in #Red2Green for us is patient safety, and the positive by-products of more green days are reduced risk and improved patient flow.
Our first task was to get the message out across the trust. We created screen savers and posters to drive home the message of "a red day is a wasted day". Our ward champions made sure that everyone on the ward understood the quality aspects of the initiative. Our champions also reassured teams that ‘red days’ didn’t mean penalties or performance management for staff – our whole #Red2Green approach has been about changing behaviours, not mandating targets.
Data from the week illustrated that the top three reasons for delay in the patient pathway were internal. Additionally, analysis of discharges during the week showed that whilst there was a slight increase in morning discharges the majority of discharges were happening later in the day with 82% of all discharges taking place after midday due to waits for review, take home medications and transport issues.
Using the data for improvement
The data gave us the insights we needed to make improvements. Because so many of the factors were internal, we were able to implement solutions in our control. Firstly, we decided to implement a three month plan of action during which #Red2Green would become embedded as “the way we do things round here.”
The plan focussed on three medical wards as champion wards, allowing us to refine the process and learn from experience before rolling out across the rest of the medical and surgical wards. We were also keen to produce a #Red2Green dashboard to illustrate not only the level and cause of constraints, but also the effects of these on individual patients.
The plan would
culminate in a ‘Home for Easter’ event that allowed us to bring together a
number of quality initiatives under the #Red2Green banner.
Our communications team continued to spread the #Red2Green message across the trust during the three months of implementation. Both staff and patient communications focused on the many health benefits of less time spent in a hospital bed. The hashtags #Red2Green and #endPJparalysis were used widely on social media and everyone was encouraged to find out more.
Nursing staff on the three champion wards were able to identify the benefits of #Red2Green for patients, and used words such as “clarity", "direction" and "confidence” to describe the positive impact for themselves. Staff on other wards were soon keen to get involved and the roll out to other areas progressed at pace.
The #Red2Green dashboard was developed and proved to be hugely powerful in communicating the impact of red days on the patient journey. Simply illustrating a stay of six days with four red blocks of days waiting for something to happen raised awareness and a desire to improve. Visual management has been a key tool for us in embedding #Red2Green.
Home for Easter
recording red and green bed days
holding an early morning board round with senior clinician presence
holding an afternoon huddle to update actions
using a central point to escalate actions and receive feedback
having a ward liaison officer to support them
How did it go?
'Home for Easter’ week was met with enthusiasm by the ward teams who worked hard to prevent wasted days, confirm plans and encourage discharges earlier in the day. Lead nurses fostered a friendly spirit of competition between themselves and an abundance of Easter eggs definitely helped! The “Wear your pyjamas to work Wednesday” initiative encouraged wards to think further about the powerful evidence behind #endPJparalysis - using a bit of fun to deliver a serious message about deconditioning and patient care. Our dashboard showed the following positive outcomes:
- increased number of discharges over the week
- a higher percentage of discharges before midday
- improved use of discharge lounge
- 0.8 day reduction in length of stay on medical short stay ward
support services were able to see the impact of improved escalation and
feedback. For example, our imaging team were able to prioritise escalations
with up to 34% either withdrawn, re-directed to other modalities or carried out
as outpatient appointments after discharge.
Next steps for the Dudley group
The plan now is to move forward with a number of initiatives classed as 'Just Do It!' These will train more nurses to carry out CHC assessments and ensure that community-based assertive case managers attend board rounds on short stay areas. Further areas of work have been identified for the longer term including a review of capacity meetings and the development of a single suite of information to illustrate capacity & demand.
We will continue to support wards in the use of #Red2Green and will count on the continued enthusiasm of our staff to reinforce this as ‘the way we do things round here’.