Pathways to rehab

Helping older patients get faster access to rehabilitation

Timeline

2015 - 2017

Team

Mater Nursing
Health & Social Care,
Patient Flow and Care of
the Older person teams
Rehabilitation teams
from Clontarf Hospital,
St Mary's Hospital,
Cappagh Orthopaedic
Hospital

Challenge

For patients over the age of 65, once they are medically stable, the optimal place to recover and rehabilitate is outside of the hospital. However, despite the frenzy of activity to find and secure suitable rehabilitation places for patients, the process was taking an excessive amount of time with duplication and errors occurring along the way.

This led to delays in transferring patients who were ready to leave the hospital as well as significant stress for patients, families and staff.

Through research, the team identified the following problems:
Problems
Poor visibility of patient status

There was a lack of clarity among staff across the hospital about which patients were medically ready for transfer and when.
Duplication of efforts

Clinical staff from the Mater hospital and from the rehab sites were assessing patients independently, resulting in duplicate efforts for staff and repeated assessments for patients.
Last minute decisions

Decisions were often made quite suddenly, with patients receiving news of their transfer on very short notice.

Outcome

The team drastically improved the overall process in a number of ways: by establishing the role of ‘rehabilitation coordinator’, designing an electronic system to give both hospital and rehabilitation staff visibility into patient journeys, and by rethinking referral documentation.

These changes have resulted in a more calm, controlled, and seamless journey from one organisation to another and is enabling patients to start their rehabilitation journey earlier.

"We’re very happy with the referral process and the documents are easy peasy to use.”

Clinical Nurse Manager, St Agnes’ Ward, Mater Hospital
Before
After
Impact
Patients are moving to rehabilitation  an average of 7 days earlier. This in turn releases more than 4,600 bed days for other patients.
The referral document was reduced from 5 pages to 1.5 pages and is completed 100% of time now - compared with 4% before.
Bed uptake rates have doubled in the rehabilitation sites.

Process

This project was conducted using a lean six sigma approach.  Our research across the Mater hospital and partner sites included:
1. Extensive interviews with staff and patients, and observations in the different
ward environments
This helped to capture the “voice of the patient” and the “voice of staff” to better understand the problem areas and pain points.
2. Data collection about patient journeys
This helped to identify variation and delays within these journeys.
3. Data collection about duplicate efforts
by staff
This helped to identify areas where staff time could be saved and the process could be streamlined.
Key staff members across four organisations carried out “Fundamentals of Lean” training, taught by the Mater Lean Academy to bring about an understanding of lean principles and systems thinking.  A series of workshops were then completed, using the collected data to tease out the areas of delay and “non-value add”, understand root cause, co-design a suite of solutions and prioritise a set of high impact interventions to address the problem.

“The interventions have simplified the process. Patients being referred are more appropriate, with more pertinent information being gathered and direct patient involvement in the rehabilitation pathway”

Dr Siobhan Foreman, Mater Hospital
This process is now firmly embedded into the operations of the hospital with the rehabilitation coordinator role serving a core function within the patient flow department.  The new pathways and processes have been successfully maintained since 2018.