Paediatrics, Swansea Bay University Health Board, Port Talbot, UK.
Swansea Bay University Health Board, Port Talbot, UK.
BMJ Open Qual. 2021 Feb;10(1). doi: 10.1136/bmjoq-2020-001142.
Discharge summaries need to be completed in a timely manner, to improve communication between primary and secondary care, and evidence suggests that delays in discharge summary completion can lead to patient harm.Following a hospital health and safety review due to the sheer backlog of notes in the doctor's room and wards, urgent action had to be undertaken to improve the discharge summary completion process at our hospital's paediatric assessment unit. It was felt that the process would best be carried out within a quality improvement (QI) project.
Kotter's 'eight-step model for change' was implemented in this QI project with the aim to clear the existing backlog of pending discharge summaries and improve the timeliness of discharge summary completion from the hospital's paediatric assessment unit. A minimum target of 10% improvement in the completion rate of discharge summaries was set as the primary goal of the project.
Following the implementation of the QI processes, we were able to clear the backlog of discharge summaries within 9 months. We improved completion within 24 hours, from <10% to 84%, within 2 months. The success of our project lies in the sustainability of the change process; to date we have consistently achieved the target completion rates since the inception of the project. As a result of the project, we were able to modify the junior doctor rota to remove discharge summary duty slots and bolster workforce on the shop floor. This is still evident in November 2020, with consistently improved discharge summary rates.
QI projects when conducted successfully can be used to improve patient care, as well as reduce administrative burden on junior doctors. Our QI project is an example of how Kotter's eight-step model for change can be applied to clinical practice.
出院小结需要及时完成，以改善初级保健和二级保健之间的沟通，有证据表明，出院小结完成的延迟会导致患者受到伤害。由于医生办公室和病房积压的病历太多，医院进行了一次健康和安全审查，因此必须采取紧急行动来改善我们医院儿科评估单元的出院小结完成流程。人们认为，最好在质量改进（QI）项目中进行该流程。
在这个 QI 项目中实施了科特的“变革的八个步骤模型”，目的是清除现有的待处理出院小结积压，并提高医院儿科评估单元出院小结完成的及时性。设定了完成出院小结的完成率提高 10%的最低目标，作为项目的主要目标。
在实施 QI 流程后，我们能够在 9 个月内清除出院小结的积压。我们在 2 个月内将 24 小时内的完成率从<10%提高到 84%。我们项目的成功在于变革过程的可持续性；自项目启动以来，我们一直稳定地达到目标完成率。由于该项目，我们能够修改初级医生轮班，取消出院小结值班，并在车间增加劳动力。这在 2020 年 11 月仍然明显，出院小结率持续提高。
成功实施的 QI 项目可用于改善患者护理，同时减轻初级医生的行政负担。我们的 QI 项目是如何将科特的八个步骤模型应用于临床实践的一个例子。
