The document describes the Safer Patient Flow Bundle implemented at Ipswich Hospital NHS Trust to improve patient flow and prevent unnecessary waiting. The bundle consists of 5 core components: Senior Review, All Patients, Flow of patients, Early discharges, and Review (SAFER). If all components are followed, it will improve the patient experience and support safe, timely discharges. The bundle led to an 11% increase in daily discharges, reduced length of stay, and allowed closure of an escalation ward over peak winter months.

1. The SAFER Patient Flow Bundle
Kate Taylor – Deputy ADoN
Becky May – Matron
The Ipswich Hospital NHS Trust

2. The ‘Safer Care Bundle’ is a combined set of
simple rules to improve patient flow and
prevent unnecessary waiting for patients.
If each core component is undertaken we will
improve the patient’s experience and support a
safe and timely discharge.
What is the Safer Care Bundle?

3. The Safer Flow Bundle
S– Senior Review
A– All Patients
F– Flow of patients
E- Early discharges
R- Review

4. All
patients
Senior
Review
Flow of
patients
Early
Discharge
Review
Right Patient
Right Environment
Right Time
Safe Discharge
The Safer Flow Bundle

5. Senior
Review
Review of sick and unstable patients
first – is the patient deteriorating?
All patients to have a Consultant or
Registrar review by midday
Board rounds take place - lasting 30
mins
All patients will have a weekend
plan in the notes including where
appropriate criteria led discharge
(Friday only).
The Safer Flow Bundle

6. All
Patients
to have
EDD
Expected Date of Discharge (EDD) to
be set within 48 hours of admission
Is the EDD realistic and reflects the
actual date of discharge?
The EDD is reviewed daily and updated
following discussion with the MDT
The patient is aware of the date
they are expected to go home
The Safer Flow Bundle

7. Flow of
Patients
Pull the first patient from EAU before
10am
Ward and assessment unit teams
communicate effectively, to know the
details of the next patient to ‘pull’
By creating assessment unit capacity
will reduce waiting for ‘new’ patients
The Safer Flow Bundle

8. Early
Discharge
A third of discharges should be before
midday
Patients prepared for early discharge
should go via the discharge lounge
Non use of the discharge lounge is by
exception
The Safer Flow Bundle
Prompt writing up of TTA’s

9. Review
Do all patients have a clear
management plan?
Is the patient waiting for any
procedures or tests?
Consider whether the care of the patient
be delivered in an alternative setting
rather than the acute Trust
The Safer Flow Bundle
Review long length of stay patients

10. Red to Green
At the ECIST Emergency Care Conference last
week Roy Lilley talks about Ipswich being the
Mecca for Red to Green.

11. Red to Green – The Process
At Ipswich this was implemented in 3 stages:
Set professional standards – identify what should happen and by when
Report & Monitor delays – ‘capture of reds in any process’
Trust and system-wide focus to share learning and unblock key constraints
together

13. Red to Green - Results
– 11% increase in numbers of daily discharges from emergency medicine base
wards across 15/16, compared with 14/15. In the past 3 months, this has
increased further, achieving 29% increase
Reduction in the Community Hospital LOS
Closure of escalation ward, minimising impact to elective activity over peak
winter months

14. Summary of growth trends seen at Ipswich
hospital NHS Trust
Year Population
nos (000s)
No. Medical
wards
Emergency
growth %
Emergency
medicine LOS
ED 4hr
Performance
2010 343 13 5.39% 6.37 97.5%
2011 351 12 -2.25% 6.49 96.6%
2012 352 12 -2.67% 6.34 95.9%
2013 352 12 7.43% 6.29 94.8%
2014 354 12 9.51% 5.67 96.9%
2015 355 13 11.43% 5.44 95.4%
2016 356 (est) 12 6.38%
(YTD)
5.22 94.1% ytd

15. 2010 2011 2012 2013 2014 2015 2016
Series1 5.39% -2.25% -2.67% 7.43% 9.51% 11.43% 6.38%
AxisTitle
Chart TitleEmergencyCareGrowth(%)
The Ipswich Hospital NHS Trust Emergency Care- Our Journey
Growth (%)
6.37%
6.49%
6.34%
5.67%
5.44% 5.22%
(YTD)
5.39%
-2.25%
-2.67%
7.43%
9.51%
11.43%
6.38%
(YTD)
7 Day
Working on Capel
Introduction
of Discharge
Coordinators
Red
To
Green
6.29%

16. Delayed transfer of care analysis
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Delayed Days

17. What’s next for Ipswich Hospital
• Extension of Frailty Assessment Base – 7/7
• Redesigned Crisis Action Team admission prevention service – including IV
antibiotics in community
• Extended therapy hours in ED
• Standardisation of admission prevention schemes
• Single point of access and assessment

19. Discharge to Assess
• A jointly funded and integrated re-ablement service established across all
pathways to deliver D2A to cope with the earlier discharge of patients
• System-wide commitment to a ‘home-first’ approach by giving people the
opportunity to return home prior to exploring D2A pathways by
preventing them from being admitted unless required
• Working with the system to promote and implement a ‘why not home,
why not now’ culture with champions within organisations
• Implementation of a D2A model which includes a ‘pathway zero’ in order
to stay focussed on ‘home first’
• Development of a step down pathway for patients with delirium rather
than placement into care.

20. Any questions?