Abstract
Introduction
During hospital admissions, there are individuals with rapidly deteriorating conditions that may be entering a terminal phase and clinicians decide ‘fast tracking’.
The purpose of this audit is for better understanding of fast track process, to estimate, improve the process and develop a checklist applicable to all Care of Elderly wards.
As a prerequisite for establishing NHS funding, documents are submitted to Clinical Commission Groups (CCG) depends on patients’ Boroughs.
After CCG approval, discharge planning is facilitated by OT and doctors (package of care, discharge summary, advanced care plan, anticipatory medications)
Methodology
Retrospective data collection (50 fast track cases from all 4 Geriatrics wards at Queen Hospital in a 3 month duration)
Results
· CCG approved 54% of cases within one working day, 22% took a day, the longest is 4 days.
· Total duration ranges from 1-25 days. Average day 6-7 days. · 9 cases are closed within 5 days (most frequency) ·
Regarding reasons for delay, Weekend/holiday is found in 17 cases, Placement in 14 cases, paperwork 10 cases and patient getting into EOL/worsening condition 7 cases.
Out of 50 cases, 11 patients are still alive but 10 passed away in a week and 9 patients less than a week.
Conclusion
•There is no standard duration for fast track.
•Main delay found from this audit is weekend/holiday. (decision made on Friday afternoon or evening, not enough time for document submission on the same day)
Recommendation
A checklist to facilitate the flow of fast track process
Comments
Intervention and learning from your audit
Thanks for the presentation, and the talk you have delivered too.
Issues with delays around fast track are common across multiple areas of the country, and have only got worse as demands on the system have increased.
I was wondering if you have started using the checklist yet? Do you know when it is likely to start to be used?
On another note, you stated that palliative care were often involved in the more complex cases, and yet these cases were discharged quicker (from my understanding of your data). Is there anything to be learned from the palliative care team about how to make the process more efficient and better for the patient? Have they been involved in developing your checklist?
Thank you for your comment.
We have introduced the checklist to Geri wards with approval from Clinical Governance Meeting since March 2022. I am yet to start second cycle of audit.
Before we conducted this audit, we seeked advice from palliative team and they have a lot of interest in this audit as well (they explained process and provided data of patients) . Palliative team also had a similar checklist which was not introduced during pandemic. When I presented this audit to Palliative team, it is acknowledged that we cannot avoid some delays like weekend/holiday but the checklist we providing would improve the process of fasttrack. Given that there is no standard duration of fasttrack, we should target for "4 day".