Using Lean methodology to support the improvement of older people’s pathways

What was the issue you were addressing or working on?

To improve entire patient pathways in the areas of Medicine of the Elderly, orthopaedic rehabilitation, stroke services and management of acute patients with dementia and delirium.[1]  Specifically to use lean methodology to:

  1. Improve flow to ensure that patients get timely access to the appropriate services
  2. Reduce lengths of stay for older people
  3. Improve health and social care interfaces
  4. Support the rebalancing of care towards care in the community
  5. Improve the management of patients in acute settings with dementia and delirium.

[1] (Care Homes not in scope for the programme.  MoE encompassed community & social care services (except Stroke, GORU & Dementia).


What you did?

Established a structure and reporting process to support work in local teams.  Pathways were scoped, information gathered and rapid improvement events held.

Activities put in place included specialist elderly assessment teams, early identification of beds, electronic referrals and early transfer to rehabilitation hospitals, criteria led early discharges including at weekends, and daily huddles to check patient progress along the pathway.

950 acute staff attended dementia awareness sessions, 130 were fully trained by an Alzheimer Scotland Nurse consultant.


What were the outcomes - benefits or otherwise?

Patients are accessing specialist care more quickly and spending less time in hospital.  They now experience a smoother transfer between acute and rehabilitation, and home via community and social care teams.  Increased therapy time is available on the wards through changes to patients’ day, and community and social care teams are now aiming to identify patients for their service rather than waiting for a referral.

Comparing 2010 to 2011, 24 of 29 wards achieved a reduced length of stay; in acute sites an average of 3.5 days have been cut from Medicine of the Elderly (MoE) inpatient stays.  Overall increase in capacity equivalent to 37 beds across MoE service.

Specialist assessment of patients >65 at front doors pulling appropriate patients into MoE wards within 24 hours.

Acute orthopaedic LoS reduced by an average of 0.5 days, which together with other actions have reduced the number of acute beds by 10, saving £239,000 recurrently.

Staff views on their ability to meet needs of older people with dementia rated as good by 85% after training compared with 38% before training.

94 extra AHP sessions per week gained at Royal Victoria Hospital after simple changes to ward routine


Contacts - to find out more

Libby Tait, Associate Director, Modernisation, NHS Lothian.
Email: Libby.tait@nhslothian.scot.nhs.uk