Knowing what to expect during your stay in hospital

‘Diarising the inpatient journey’ is a new project led by University Hospitals Birmingham NHS Foundation Trust as part of the Health Foundation’s Shared Purpose programme. By giving patients a schedule of the elements of care and treatment they can expect during their stay, it aims to improve communication with patients, encourage timely provision of care and help to reduce length of stay.

Currently, hospital inpatients are given little information about the schedule of treatment during their stay in hospital. Patients are given an anticipated leaving date, but often little information on when things like diagnostics, operations or physiotherapy are planned, making it difficult for them and their families to know what to expect.

The ‘Diarising the inpatient journey’ project wants to address this by providing patients with a diary of planned interventions during their stay. The project, currently in its planning stage, aims to bring corporate and clinical services together, working alongside patients, to give patients more information and control in relation to their care.

As well as improving the experience of care for patients (improving communication and ensuring interventions are more coordinated), the project will also play an important part in linking the scheduling of service provision with patients’ individual care plans.

Lorraine Simmonds, Head of Service Improvement at University Hospitals Birmingham, is leading the project. She explains how the team is involving patients in the planning and design of the diary:

'We ask our patients for feedback all the time and compare it with national patient survey results. One thing that stands out is that patients say we don’t communicate very well with them about what’s happening during their stay, and they find it really frustrating not understanding the ward routine. We want to empower them and help them to feel in control of their journey.

'We want a diary designed by patients, for patients. We’ll interview a group of recent inpatients, as well as some relatives. We’ll explain the typical inpatient journey and ask them what their experience was as they went through that process, so we can shape our design principles. With colleagues in the hospital, we’ll design options to show the group and ask for their feedback. We’ll do the same exercise with staff.'

The project builds on lessons learnt from tools such as integrated care pathways, which have been shown to reduce length of stay, reduce costs, improve outcomes and increase patient satisfaction. These approaches have proved an effective starting point for discussion about a patient’s care plan and helped patients to understand their treatment, reducing anxiety about their stay.

Lorraine explains how by redesigning ward processes and making better use of existing IT systems, corporate and clinical teams will work together to engage patients in the planning of their care and manage resources more effectively:

'Nurses will get a view of the whole ward, including the busy times, to help them prepare for things like patients going to scans. This project is about process and communication, not developing new IT systems. We need to mine the data from our existing IT systems and show it in a diary for each patient. It’s an extraction of existing data from existing systems. That’s what makes it simple and possible to replicate.'

Inpatients will be given a diary of the events planned during their stay, including the expected date and time of discharge, meal times, ward rounds and visiting times. The key difference to existing systems is that the diary will act as a central point to coordinate booked events from multiple services, while focusing on the needs of the patient. Nursing staff will use the diary as a starting point to engage with the patient and their carers daily.

'The University of Birmingham, our project partner, will interview patients who have used the diary to get their feedback. We’ll also compare the outcomes in those wards that have diaries with the wards that haven’t. A key measurement is average time of discharge: can we make it earlier in the day as a result of better planning and communication? We’ll also measure staff satisfaction, with and without the diaries.

'We want to make the diary work on paper. If we can make it work at that basic level, it could be replicated across the whole NHS.'