The Daily Dynamic Discharge Approach

THE DAILY DYNAMIC DISCHARGE APPROACH

IMPLEMENTATION CHECKLIST

The key to sustainability, and to making the DDD process ‘just part of the way we do things round here’, is considering all of the necessary conditions at the outset of implementation. Completing this checklist will ensure that you consistently consider the pre-requisite conditions for success (and are able to take action to mitigate risks to sustainability, or amend or remove anything that is not necessary or appropriate for your site/area).

This document is designed to be used by the person implementing the DDD approach, and in conjunction with the DDD guidance document.

IT PREPARATION

TASK COMPLETE? Ensure the ward’s discharge plans (estimated discharge dates) are viewable electronically (wardview or other system) Ensure there is an electronic whiteboard/screen in an appropriate place for the morning meeting Ensure the Ward Manager (or Senior Charge Nurse) is able to access it and knows how to obtain the correct view (order by EDD) and update the content Set up wardview training (if necessary)

GENERAL SET-UP

TASK COMPLETE? Choose the ward/wards you wish to implement in Meet with the Senior Charge Nurse or Ward Manager first to explain the process and the rationale for choosing the ward and the benefits they can expect to see Meet with the consultant/s to explain the process, what they can expect to gain from supporting the implementation, and secure agreement for the junior doctors to start their day by participating in the DDD meeting Meet with the AHP lead and therapists who cover the ward to explain the process and agree participation and attendance at the daily meeting Meet with the management team who cover the ward (General Manager, Lead Nurse, Clinical Services Manager) and agree their support for CCC and implementation Obtain benchmark measurements for the ward performance (discharge numbers, ALOS, pre-noon discharges, discharge lounge utilisation) and any other appropriate measures Choose where the daily meeting will be held with the SCN/Ward Manager Agree day to begin Communicate ‘go live’ details via the SCN/Ward Manager to the rest of the ward team Devise a ‘check, chase, challenge’ rota of support with the management team – who will go to what ward on what day (agree which days you will cover with them, and when they will cover alone) Agree who will facilitate the first few meetings Before go live day – make sure all patients are in wardview and have an EDD and a plan (ensure the NIC knows about the meeting, if not the ward manager/SCN) Email the relevant paperwork to all – task sheets, quick guides, scripts Prepare a folder for the ward with task sheets in and print out the scripts

ON ‘GO LIVE’ DAY

TASK COMPLETE? Get to the ward early and help the SCN/Ward Manager convene the group Agree where the task sheet folder will be kept (ensure facilitator tells the group how to update their tasks) Agree afternoon catch up process, 5 minutes post ward round to update or record any changes or additional discharges

UNDERPINNING SUSTAINABILITY

TASK COMPLETE? Explore ‘golden hour’ ward rounds with the consultants – sick patients first, then those for discharge and everyone else afterwards (this supports the prioritisation of tasks in the DDD meeting) Devise an escalation plan to be called upon when delay is identified (names, numbers, examples) Create a review process with the Lead Nurse and the SCN/Ward Manager; develop an improvement trajectory based on the ideal ‘discharge numbers’ and benchmarked data, schedule monthly meetings to review improvement and agree actions Agree communication strategy with SCN/Ward Manager to share data with the wider ward team Agree process at the weekend with the SCN/Ward Manager and ensure it is communicated