The Home for Lunch project began in 2022 and was initiated as a Quality Improvement project. It is a concept that has gone on to improve both patient experience and staff morale on the ward.
At its core, Home for Lunch is a very simple idea – patients who can be discharged, are discharged from hospital before lunchtime. This may sound like such a simple change, but it has helped to drastically enhance service user experience and relieve stress points on the ward’s workforce in numerous ways.
Area Matron Kate King said: “The length of a patient’s stay was increasing, our acute partners were under unprecedented levels of pressure so we decided to really look at the whole of the way our patients came into our beds and how they are discharged. We decided to look at our process through a QI lens, and we ran a workshop facilitated by Dean Garrett of the Southern Health Quality Improvement Programme. We mapped out the patient journey and we looked at two specific areas where we thought we could streamline the whole process. These two key areas were the daily ward planning meetings and the main Home for Lunch project.
"We broke into two teams, with one looking at the admissions and one looking at the discharges. The main issue with admissions was the paperwork and the daily call we would have at 10:00 every morning. This call would have 8 to 10 people on it, and we would go through every patient’s details and needs, and sometimes the call would last for 30 minutes or more. It was taking staff away from the wards and from the patients.
"Using the QI methodology to streamline the paperwork, we made the decision to have only two members of staff on the call each day. This freed up time for them to work on the ward and do their jobs.”
The changes Kate and her team made to the morning meetings resulted in a shorter call, with less paperwork and fewer people pulled away from their duties on the ward.
Kate continued: “The savings we made equated to the meeting time being reduced to 10 or 15 minutes, took people away from clinical duties for less time, and the financial cost saving was estimated to be approximately £25,000 – that’s the equivalent to another nurse being employed on the ward.”
The main success of the Home for Lunch project was in the revamp of the process for discharging patients who were well enough to be sent home. A major issue the ward was facing was discharges taking place later in the day during the late shift. Due to the demographic of service users being predominantly elderly people, having them discharged during late afternoon or evening led to a less than ideal situation not just for them but also for the staff on the ward.
As Kate explains: “We were discharging patients during the late shift, which meant we would also be admitting new patients as beds became free. On the late shift we had issues such as fewer doctors and nurses on shift, and more visitors on the ward visiting existing patients. Data has demonstrated that this is a high activity period with less resource and due to this, the majority of our incidents would happen on a late shift. Staff were also reluctant to switch to a late shift, if needed, because it was so busy.”
To combat this, the Home for Lunch project aimed to discharge patients before lunch. This small change led to massive improvements to staff wellbeing and morale, experience of service users and their safety, as Kate explains: “Because we are now freeing up beds earlier in the day, new patients are able to be admitted earlier, be seen by Doctors who are still at work. With more staff on duty, gaps or issues on admission are addressed far earlier. For the patients going home, they are getting home during daylight hours, meaning that shops and pharmacies are still open, they can be in their home without it being dark and everything being shut.
“It also helps the staff on the ward, as work can be planned across the whole day and staff are less reluctant to swap to a late shift! Welcoming a new patient is now less stressful and a more pleasant experience for all. Just getting a patient ‘home for lunch’ has improved patient experience, patient safety and staff working experience.
“There has been some pushback, so we really have to sell it to people but when we explain how it benefits their parent or relative, they see the positive reasoning behind Home for Lunch.”
Using Quality Improvement techniques, Kate and her team In Physical Health Inpatients have streamlined their process and improved patient experience and safety, and as a knock-on effect, has improved the working experience for staff. Home for Lunch means that patients are not returning home in the dark and instead arriving during daylight hours when partner agencies are still able to perform home visits, and GP surgeries, shops and pharmacies are still open. For more information on Home for Lunch, download the information leaflet here.
If you would like to know more about how the Quality Improvement Programme can help your team, please get in touch at qi@southernhealth.nhs.uk.