COMMUNITY HOSPITAL CASE STUDY
Releasing Time to Care – realising the benefits
The ward began implementing Releasing Time to Care (RTC) in March 2010.
1 year on, the team have implemented the three foundation modules, meals and
medicines and are in the process of implementing the handovers module.
Increasing Direct Care Time
Our baseline direct care time has risen from 27% in July 2010 to 30% in April 2011
and will be repeated in October 2011.
Direct Care Tim e
Jul-10
30%
Apr-11
Apr-11
28%
26%
Jul-10
24%
The total number of interruptions has also increased, but interruptions for location of
equipment have reduced from 16% to 2% since implementing Well Organised Ward.
Interruptions
45%
40%
35%
30%
25%
20%
15%
Jul-10
10%
Apr-11
5%
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0%
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Improving patient safety & reliability of care
Before implementation of RTC medicine rounds were at 08.00, 10.00, 12.00, 14.00,
18.00 and 22.00 (6 rounds). Night staff did the rounds at both 22.00 and 08.00. The
number of medicine rounds between 08.00 and 14.00 meant that one staff nurse
was occupied with drugs completely for most of the morning. The number of drug
errors were high especially the 08.00 round. There were also many interruptions
during the rounds.
By working through the medicines module of releasing time to care the team have
reduced the medicine rounds to four at 08.00, 14.00, 18.00 and 22.00. The day staff
now do the 08.00 round (immediately after the handover), so the night staff only do a
medicine round at 22.00. By promoting a culture of the staff nurse doing the
medicine round being more proactive in preventing interruptions has made a
substantial improvement in drug errors. These improvements have reduced the
number of drug errors from 12 (November & December) to 8 (January, February &
March)
Number of drug errors reported on Datix November 2010 - March 2011
12
10
8
Number of drug errors
reported on Datix
6
4
2
0
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Improving efficiency of care
The time released has contributed towards improved clinical care for patients.
Following implementation of the Meals module compliance score with the Food,
Fluid and Nutrition clinical quality indicator (CQI) has consistently remained within
the target zone of 95 - 100%.
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FFN CQI Compliance
100%
90%
80%
70%
60%
Compliance
50%
Target
40%
30%
20%
10%
15
/0
7/
20
10
15
/0
8/
20
10
15
/0
9/
20
10
15
/1
0/
20
10
15
/1
1/
20
10
15
/1
2/
20
10
15
/0
1/
20
11
15
/0
2/
20
11
15
/0
3/
20
11
15
/0
4/
20
11
0%
In the same period compliance score with the Falls CQI has not been consistent.
During the period of December 2010 to March2011 there were high levels of staff
sickness, including the Senior Charge Nurse who was absent for most of that time.
Compliance has improved recently, which may be due to the return of the Senior
Charge Nurse, although staff members are responsible for maintaining standards
even when the Senior Charge Nurse is not there.
Falls CQI Compliance
100%
90%
80%
70%
60%
50%
Compliance
Target
40%
30%
20%
10%
15
/0
7/
20
10
15
/0
8/
20
10
15
/0
9/
20
10
15
/1
0/
20
10
15
/1
1/
20
10
15
/1
2/
20
10
15
/0
1/
20
11
15
/0
2/
20
11
15
/0
3/
20
11
15
/0
4/
20
11
0%
Improving patient experience
We attempted to complete a patient satisfaction survey in 2010, but found obtaining
enough completed data challenging due to the type of patients and length of stay.
Following assistance form the Clinical Governance and Risk Assessment team we
are planning to repeat this exercise starting in May 2011using a different process.
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We also plan to use ‘you said, we did’ boards to inform patients and their relatives of
the results and improvements.
Improving staff well being
We completed a staff satisfaction survey over 4 months in 2010 in which staff were
asked whether their shift had been good, bad or ok. Results were variable, but the
final survey was only completed by 4 staff members, which makes the result
unreliable. One of the challenges was persuading the staff of the benefits in
completing the survey. Now that RTC is embedded into normal working practice we
will be repeating this survey over the next 4 months to compare results.
Staff Satisfaction
100%
4%
0%
27%
38%
0%
90%
80%
25%
70%
66%
25%
60%
Bad Shift
50%
OK Shift
Good Shift
40%
69%
30%
62%
50%
20%
33%
10%
0%
Apr-10
May-10
Jun-10
Jul-10
After we started implementing RTC we did a comparison of short term sickness
between April to July 2010 and the same period in 2009. This showed an
improvement from 43% to 20% as percentage of days lost per month.
We are currently collecting the data to compare the same period for 2011.
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Staff sickness
50%
43%
45%
43%
40%
35%
35%
30%
26%
2009
25%
20%
20%
2010
20%
15%
10%
5%
0%
April
May
June
The resulting cost saving was £4,275 in bank usage
Reduction in Cost of Bank Usage
25,000
22,100
20,000
17,825
15,000
2009
2010
10,000
5,000
0
We have recently implemented a dashboard for reporting RTC and CQI data on a
monthly basis. This should make our data collection more robust and improve our
processes for identifying challenges.
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