the admitted patient specialty ward dr alistair dorward consultant respiratory physician royal...
TRANSCRIPT
The Admitted PatientSpecialty Ward
Dr Alistair DorwardConsultant Respiratory Physician
Royal Alexandra HospitalPaisley
A C U TE M E D IC IN E
A cu teG en era l
W ard
A cu teG en era l
W ard
A cu teG en era l
W ard
A cu teG en era l
W ard
A cu teG en era l
W ard
C C U
Acute Admissions
Surgery
Patient Flow
Acute Admissions
Home
Home
Chronic/complex patients seen by appropriate
specialist
Hanlon, Beck, Robertson, Henderson, Capewell, Dorward . Coping with the Inexorable Rise in Medical Admissions: Evaluating a Radical Reorganisation of Acute Medical care in a Scottish District Hospital. Health Bulletin 55 (3) 1997
Before After
Cardiology 34% 58%
Respiratory 53% 67%
Asthma 44% 93%
Specialty Wards
Speciality Ward Flow
Barriers to Patient Flow• Medical
– Unwell – Dying – Symptom control – Requiring O2– Poor mobility
• Medical Administration– Waiting ward round– Waiting consultant – Waiting specialist / Geriatrician
opinion• Waiting
– Social work – AHP – Transport – Long term care
• Other waits – Radiology – Endoscopy – Bronchoscopy– Pulmonary function– Transport– Other investigations
• Refusing home – Patient – Relatives
• Patient Boarding
RAH Respiratory Unit
39 beds – 1 empty
RAH Respiratory Unit
• 19 male• 1 day case• 1 elective admission
RAH Respiratory Unit
COPDCurrent discharge procedures in UK hospitals• Only 53% of patients were seen by a respiratory physician before discharge;:
69% were seen by a specialist nurse• Only 32% of hospitals use a formal discharge check list• Only 22% of hospitals have a COPD discharge pack for Patients• Only 25% felt ready to leave hospital• Only 26% felt able to cope at home• Only 37% felt reassured that good support was available at home• Only 34% felt informed about their COPD and reasons for admission• Only 52% of hospitals refer patients directly to pulmonary• rehabilitation• Only 63% of hospitals refer patients to their smoking cessation• service
Bed occupancy by illness
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