@Marktheliverdoc I particularly enjoy the Cancel all out patient clinics because the hospital is full and go and see your patients 4 times today instead to see if Doris has magically become mobile, Jim has become non septic in 3 hours or Dai's package of care/social worker allocation has occurred

@docdai I agree- a crazy quick fix that doesn’t work long term ( or possibly at all). But we do need to focus people on the importance of those small improvements which feed into virtuous cycles

@Marktheliverdoc The unfortunate truth is that if you want to absolutely minimise LOS you need to have somewhat obsessional oversight at senior level. Often multiple barriers put in our way that we have to work around. But it can be done!

@BrainTumourSurg We need to change the model… You are right -you have to have oversight, but people on the ground need to be aware that their well intended actions may compound the problem. We all do our best for “our” patient- but we need to be conscious of one’s we can’t see!

@Marktheliverdoc I agree Mark but I don't think the pressure of no flow and patients lined up in ED for 12+ hours is felt by us on the wards. I think the idea is marginal gains and thinking can I send the pt home a day early and OPD fu/imaging rather than stay in. But not easy!

@TAkbar But these marginal gains add up- less safari ward rounds, patients who are actually Weller arriving on the ward ( not de conditioned and confused by a day on a trolley), more likely to keep ward based care with all its benefits- a virtuous cycle potentially 🙂.

@Marktheliverdoc Ultimately this is all a function of the size of the demand capacity gap. We are spread far too thin and try to do too much. Organisations also only see what’s in front of them and not the upstream impact of over prioritising inpatient work.

@Marktheliverdoc PF practiced in silos is always going to be suboptimal. Working on a hospital where patient transport is seen as witchcraft is quite a challenge. @JKMVidimo will undoubtedly concur.

@Marktheliverdoc Feels like the AMUs get hammered with these requests of "prioritise discharge" whereas the inpatient wards don't.

@Marktheliverdoc Lots of good points in the thread. I think its right that inpatient areas feel the pressure of admission from ED move the risk safely. If patients can go home tomorrow what's stopping them going today? If a speciality accepts a patient they need to clear a space bt bording

@Marktheliverdoc I've had a quick look for RCTs comparing discharge decision-maker roles. Not found any yet. Will keep looking. Found or not, IMO we need RCTs to help us determine what is best in this more complex and high intensity environment #PatientDischarge

@Marktheliverdoc ritualistic meaningless, "something must be done and seen to be done" cascades of calls, messages, screen savers, emails "what the feck do you *think* we are doing already? Keeping people for fun?"

@Marktheliverdoc Agree but try to take it in good grace. If not told the position is poor & more D/C are required & something catastrophic happens then at the public inquiry when the team are asked “Did you tell the clinical teams about the operational challenges?” & you say “no” - you’re dead.

@Marktheliverdoc Is there a reason it isn’t being addressed?

@Marktheliverdoc And from the other side even 20 yrs ago GPs got regular exhortations to consider alternatives to admission as if we sent patients to hospital for fun.

@Marktheliverdoc I always thought you kept your favourite patients longer than necessary /s

@Marktheliverdoc 'Prioritising discharge' is not good phrase. Care needs to be well organised thru whole pathway to reduce LOS. This RCT found that seeing 'anticipated for discharge patients' at start of ward round didnt bring significant earlier discharge or reduced LOS.