A Day in the Life of...Sandy Jones, Glan Clwyd Hospital's Discharge Lounge team leader
17.05.23
Sandy Jones has one aim during her working hours – reducing the number of people waiting for a bed in Glan Clwyd Hospital.
Communications officer Jez Hemming went to meet Sandy, team leader of the site’s Discharge Lounge. It’s function is to increase patient flow through the hospital.
With her team of five registered nurses and seven healthcare support workers, she is focused on finding patients who are fit for discharge and removing barriers to them going home.
Sandy explained how for each patient admitted to the discharge lounge up to five other patients could move around the hospital.
She added: “So it has a really big effect on patient flow. When you walk down to ED and you see what’s there - it’s about us all working together to get people home, so new arrivals can be moved off trolleys and into hospital beds.”
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Moving someone out of a bed on a ward to the Discharge Lounge means someone in another area of the Emergency Quadrant (EQ) can take that space.
Someone could then move from the emergency room to another area within the EQ. Another patient could then be taken off an ambulance and into hospital. It’s a simple concept that’s much harder in practice.
However, research shows discharging people from wards earlier in the day improves patient flow through the entire hospital. The team will manage blood transfusions, IV antibiotics and infusions, dressing changes and district nurse referrals, among many other procedures which could get patients off the wards sooner.
“It might be patients are just awaiting a blood test,” said Sandy. “Why wait on the ward when they can wait down in the Discharge Lounge and have it done there more quickly?”
She used to work on the wards, so who better to liaise with them and help get patients home more speedily?
“It seems like this job was made for me,” Sandy revealed. “The Discharge Lounge is a vital part of the hospital but it’s unseen.”
Sandy checks the list of anticipated discharges for the day
Arriving on the department at 8.15am, Sandy can be seen checking the rotas and making sure there’s a full complement of staff. Today there is.
The area can accommodate up to 24 people at once and moves up to 34 who are fit for discharge out of Glan Clwyd each day – around 10% of the hospital’s population.
It’s 8.20am. There are already three people waiting for booked ambulances (the Discharge Lounge can arrange this) and three more are waiting for community hospital (step-down) beds.
Despite the team’s best intentions, things don’t always go to plan - as Sandy explained: “Sometimes people will not leave and can be sitting there all day. Sometimes it might be a medical issue. Sometimes it can even be because the family won’t take them on that day.”
Sandy’s team of progress chasers visit every hospital ward looking for people suitable for a safe discharge.
She makes the point it’s not a case of discharge at all costs, it is about finding those people who are medically fit to leave hospital but are being held up by something easily and quickly fixed.
In the reception area, one of Sandy’s progress chasers tells us a nurse is in tears on an upstairs ward because they are so understaffed. She said she’ll return for the patient in half-an-hour.
We follow Sandy to Ward 12 where the board round is due to start. Board rounds are regular meetings held on wards, which discuss the status of patients with doctors, nurses, occupational therapists, physiotherapists, consultants and other health professionals.
It is fertile ground for Sandy, who will offer to take patients who may be suitable for discharge back into the community.
One patient is ready to go home but needs a special bed installed in her home. She can’t move until it is in place and Sandy makes a note to follow it up.
Another is fit for discharge today but is awaiting a doctor’s assessment. A nurse vows to get this completed and Sandy adds the patient to her list.
A patient fit for discharge refuses to walk, despite physiotherapists saying she is able to with help.
We move to Ward 11 and find another patient who will be eligible for discharge today and bypass another ward, which was closed at the time due to Covid infections.
Ward 5 yields a further three patients and the promise of even more later, following the ward rounds.
Sandy explained how there was a push to change how ward rounds are conducted across the hospital.
She said: “One of the issues is the rounds take place late in the morning and this can have a really big knock-on effect on admissions.
“So work is going on across the hospital to get rounds completed earlier so patients can be discharged more quickly.”
It is 10.15am and we hear there are 82 people waiting in the emergency department, with 41 of them awaiting a specialty assessment. Seventeen need a hospital bed.
Healthcare support workers can take up to 22,000 steps every day, circling the hospital in a bid to get patients home in a timely manner.
After a brief stop for a drink, we got to Ward 7 for the 11am board round. Sandy hopes we’ll find some more eligible patients.
One patient can go home if a special mattress can be sourced. Sandy’s team will chase this up.
Another patient awaits blood tests and an assessment on whether they are safe to go upstairs using two handrails.
“Every day brings a different challenge and no two days are the same,” said Sandy. “I’m really passionate about this place and how I can make a difference.”
The team is helping to discharge more than 30 people each day, on average.
“I’m really proud of that,” she adds with a smile. “You’ve seen what a difference this makes to the hospital, so it’s important we have the staff to keep this running.”
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