Patients: Implementation of SAFER across medical and surgical wards during the 1st Quarter of 2019

The problem

The senior management team had identified issues with inpatient flow, length of stay and increasing waits in the Emergency Department. Although SAFER had been adopted in the hospital previously this had not been sustained and when Alamac commenced work in the acute hospital in December 2018, it was not being used in the medical or surgical wards.

What we did

  • A baseline audit of key elements of the SAFER bundle was conducted for each of the medical and surgical wards.
  • The development of a bespoke “Kitbag” with ward specific goals identified to meet targets of “what good looks like”
  • Frontline coaching and education of the key components of SAFER
  • Ward – based coaching and challenge to improve the setting of multi-disciplinary EDDs
  • Support and facilitation to commence Board Rounds and afternoon huddles
  • Coaching to enable discharge planning discussions for super-stranded patients at Board Rounds and Medically fit for discharge meetings
  • Development of standardised whiteboard format and standardised operational procedure for Board Rounds
  • Weekly data analysis and reports for key stakeholders including ward staff and executive leads
  • Data analysis used to identify ward/department action plans and areas for improvement
  • Dedicated SAFER meetings for project sponsor/leads to discuss progress on implementation of SAFER with ward staff

What we achieved

Establishment of trust and effective relationships with ward teams enabled an increased understanding and recognition of the benefits of SAFER for patient care and flow.

This translated into setting of multi-disciplinary EDDs ensuring a focus on discharge planning in tandem with the need for acute care.

Recognition that the analysis of data was a way to identify areas of good practice and areas where improvement was necessary, and subsequently to measure improvement in an objective manner.

Having safety huddles impacted on the number of early discharges:

Implementation of the SAFER Bundle correlated, as would be expected, with a decreased length of stay on surgical wards:

Implementation of the SAFER Bundle correlated, as would be expected, with an increase in discharges on medical wards:

Improvements were then seen in a range of measures over the implementation period: