Norfolk and Norwich cuts discharge delays with referral system

Norfolk and Norwich University hospital trust has developed a single electronic referral system, to help reduce delays in patients accessing clinical therapy and support services when they are discharged from hospital.

In April 2010 the trust’s 950 ward hospital had an average of 55 patients per day delayed in leaving hospital, but by April 2011 this had declined to an average of 31, a 45% decrease. The trust said that the system has improved the visibility, responsiveness and communication between teams during the discharge process.

Anna Crispe, associate director of service improvement at Norfolk and Norwich, told Guardian Healthcare that before the system was put in place just over a year ago, the hospital routinely had up to 70 patients every day waiting to leave. This would include patients waiting for an assessment, which might be from therapists, social services or the community reablement team.

“They couldn’t go because they were waiting for something and that’s about two wards full of patients if you want a sort of simple way of thinking about it,” she said. “What was quite difficult about this was that all of the referrals to the various teams were all done using different pieces of paper that went through different routes that did or didn’t get accepted, and the visibility of the process was very poor.”

Previously a nurse would complete a form and fax it to the relevant department. Crispe said that usually the transfer would be booked successfully, but no one would know when and how it would happen, and sometimes if the form wasn’t completed correctly then nothing would happen.

“The point of this project is to use our internal electronic ordering system to order assessments and reviews. So if you’re now the nurse sitting on the ward, instead of filling in a piece of paper and faxing it off, you do a request on the electronic order system for whoever it is to come and review that patient whether it is a physiotherapist, or the social services team or whoever,” she explained.

Now staff are able to see who has logged a request to which department and whether a member of staff has been allocated. The system was first piloted on a few wards for three months and has now been rolled out to every ward within the trust. Crispe said that patients are no longer waiting at the hospital for any longer than necessary.

The project has also led to more than 90% of patients having their social work assessment completed within six days of referral, compared to 31% in April 2010. It has also helped to halve the number of patients waiting more than six days for a community liaison team assessment from 17% to 8%.

Crispe said that staff at first were slightly apprehensive about using the technology, but because it has delivered clear benefits they are now receptive. “You shine a light on things and it makes people question why you’re doing it and how well they’re doing,” she said.

She added that the system “is not perfect” and is not as responsive as the hospital would like, but believes that the fact that people within the organisation and outside it are asking to use it illustrates how valuable and useful it is.

Norfolk and Norwich’s work has been shortlisted for a HSJ Efficiency Award in the category of efficiency in clinical support services. The awards take place in September.