Tom Downes: The acute care pathway for the older patient

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Tom Downes, Clinical Lead for Quality Improvement at Sheffield Teaching Hospitals, spoke at our conference, Making health and care services fit for an ageing population. Tom discussed the importance of system organisation, drawing on his experiences in Sheffield, where positive outcomes are emerging from system redesign.

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Tom Downes: The acute care pathway for the older patient

  1. 1. The Acute Care Pathway and the Older Patient Tom Downes MB BS, MRCP, MBA, MPH (Harvard) Clinical Lead for Quality Improvement Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 22nd October 2013 @sheffielddoc
  2. 2. CHARLOTTE
  3. 3. Hospitals are bad places for old, frail people Sir David Nicholson, January 2013
  4. 4. Older, frail patients with multiple problems need a different approach. A part of the NHS must be custom-tuned to their needs. Roy Lilley, The Guardian 29th May 2013
  5. 5. A Complex System Problem
  6. 6. 2003 Toyota Corolla
  7. 7. How do others design complex systems? Toyota Oobeya (Big Room)
  8. 8. First find a room
  9. 9. A place to meet
  10. 10. PDSA tests of moving from ‘post take’ to ‘on take’ Let me introduce ‘George’ •82 years old •Lives independently and wants to continue doing so •Widowed 5 years ago •Has mild dementia •Daughter lives locally •Losing weight + poor mobility
  11. 11. Implementation: • April 2012 •Consultant geriatricians ‘on take’ 7 days per week • May 2012 • Frailty Unit process initially virtually • Frailty Unit opens mid-May • July 2012 • Ambulatory care area for work formerly considered to be outpatient
  12. 12. Outcome measure: 34% increase in discharge day 0/1
  13. 13. Outcome measure: Bed occupancy reduced by over 60 beds
  14. 14. Was reduction in bed usage due to reduced admissions? No
  15. 15. Balance measure: Would it have happened regardless?
  16. 16. Balance measure: No increase in readmissions
  17. 17. Balance measure: Decreased mortality
  18. 18. CONCLUSION • Modern health care is complex • Iterative testing is essential to overcome the complexity • Redesign by staff with patients • Process not structure • Measure • Health and social care cooperation vital
  19. 19. CHARLOTTE
  20. 20. Thank you Tom.Downes@sth.nhs.uk @sheffielddoc

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