Learning Objectives: At the end of this activity, you will be able to:

• Describe how one hospital used PDSA cycles to help frail elderly patients return home faster
• Discuss the benefits of redesigning the discharge process

Description: At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3–4 days faster in one year, saving as many as 40,000 hospital bed days. “That’s four extra days at home, getting back to independent living with a patient’s family,” says Tom Downes, Clinical Lead for Quality Improvement at Sheffield and former IHI Fellow. “And we know very well that’s what our patients want.“

Discussion Questions:

• Were you surprised that the patient in the story could do more at home than in the hospital? Why or why not?
• Why might some staff resist flipping the discharge process? If you were on this improvement team, how would you respond to their concerns?
• The improvement story at Sheffield began when a staff member asked a "why" question about the current process. Can you think of an experience where you learned something by challenging the status quo?