Abstract
Introduction High number 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 bed base from 32 to 72. This gave the opportunity to review how these patients were managed.
Method It was recognised that a daily medical ward round for clinically optimised patients was neither necessary or optimal and potentially perpetuated the impression that patients required in hospital care. National guidance supports delegation of daily review to other members of the Multidisciplinary Team. All clinically optimised were planned to be seen once a week on a medical 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 four weeks period one third ( 24/72 ) of patients needed review outside of the weekly planned review. Of these 79.2% required only one review. Junior doctors reported that they previously spent 5-15 minutes per day per clinically optimised patient. Therefore time saving of 16-48 hours per week was estimated. Balancing measures of falls, mortality, pressure sores and complaints showed no change in the four months after implementation of the change. Patients, family and staff qualitative feed back was gathered. Stage two of the project offered clinically optimised patients a ' What Matters to Me' meeting with their family utilising the time saved by reduced ward rounds 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 at admission in the Emergency Department and Acute Frailty Unit.