SAFER-f Patient Flow Medicine Bundle

MRHCPs will:

• Complete an initial assessment for newly admitted patients within first 24 hours.
• Include inter-disciplinary team members.
• Include frailty, mobility and delirium assessment tools.
• Ensure assessment findings are understood, documented and accessible to all unit team members.

Rounds are crucial to decision-making and care coordination.

• Should add value, leading to clear actions, written up in notes and acted upon.
• Should be undertaken daily by noon, to enable teams rapidly to assess the progress of every patient in every bed.
• Patients, families and their essential care partners should be informed of progress, and any delays to treatment or discharge need to be addressed and communicated.
• Use checklists to reduce variation and prevent actions being omitted.
• Always include a most responsible health care provider (MRHCP), qualified nurse, other member of the multidisciplinary team (MDT), Continuing Care and/or other community partners, and involve patients, families and essential care partners from the outset.
• Use a ‘dedicated member of staff’ to lead on the management of ward patients.
• Let specialty colleagues focus on elective and other activities.
• Complete most tasks (e.g. writing/preparing discharge prescriptions or ordering tests) while in rounds, if possible, to avoid overloading junior staff, batching tasks and creating delays.
• A second afternoon board round is best practice to review progress.
• Consider use of the SHOP method to facilitate order of patient rounding.