Finding early opportunities to access Community Services Discharge to assess work stream Bie Grobet South Warwickshire Foundation Trust 1 2 Warwickshire North CCG challenges Nuneaton and Bedworth top 13 most deprived areas in England ID: 266653
Download Presentation The PPT/PDF document "‘Navigating the System’" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
‘Navigating the System’
Finding early opportunities to access Community Services- ‘Discharge to assess’ work streamBie GrobetSouth Warwickshire Foundation Trust
1Slide2
2Slide3
Warwickshire North CCG challenges
Nuneaton and Bedworth : top 1/3 most deprived areas in EnglandWarwickshire: 26/37 deprived areas are in Nuneaton and BedworthRural North Warwickshire: 18.3% >65 years old3Slide4
George Eliot Hospital
District General HospitalServes a population of 290,000North Warwickshire, South West Leicestershire and North Coventry352 beds4Slide5
Bed based model
Community Team modelNHS WarwickshireBramcote Hospital41 bedded Rehabilitation UnitReduced to 20 beds 2008/09Option appraisal for re-provision 2010Closure April 2011
5Slide6
4 Principles to improve Care for
Older People (Prof. Ian Philp): ‘Choose to admit’ only those frail older people who have evidence of underlying life-threatening illness or need for surgery – they should be admitted, as an emergency, to an acute bed Provide early access to an old age acute care specialist, ideally within the first 24 hours, to set up the right management plan‘Discharge to assess’ as soon as the acute episode is complete, in order to plan post-acute care in the person’s own homeProvide comprehensive assessment and re-
ablement
during post-acute care to determine and reduce long term care needs
6Slide7
Simplified access
Emergency CapabilityReducing variation
Expansion of Intermediate Care and Virtual Ward Services- Doubling capacity and workforce
Service opening hours: 8.30 am till 12 Midnight
Development of Community Emergency Response capability- 2 hour response
Simplified referral criteria – ‘Discharge to Assess’
Drive to improve confidence and understanding of Community Services by Acute and GP colleagues
Reducing variation: 5 Daily Discharges- managing Acute and Community flow commitment
7Slide8
‘Orange’
and ‘Green’ Flow:Bed days for adult emergency admissions 2008/09Source: Dr Foster Intelligence &NHS Institute (2011)Slide9
‘5- A- Day’ Project
Community NavigatorsProject Manager role across Acute and Community
Early opportunities for 5 patients to be discharged daily
2 Community Nurses navigating patients to Community Services
Project Manager working across Acute and Community
2 work streams: ‘
Orange flow
’ short stay, ‘
Green flow
’ ward stays
677 patients supported
Shared data collection to measure success
9Slide10
Retraining Community Hospital staff
Change of culture and approach‘Hearts and minds’ presentationsSenior Leadership sign up and ‘Can Do’ approach
Ward level engagement in discharge planning
Integrated Emergency Care Board
CCG and Board (x2) support
Change management
Improving confidence
Whole system sign up
10Slide11
Closure of Community Hospital savings - £2.07M:
£1.03 M reinvested in Intermediate Care and Virtual Ward Services£400k invested in Intermediate Care beds in Nursing Home
£1M of further savings re-invested in Acute contract
18 Acute beds closed
Winter capacity only opened sporadically
Re-investment
Acute Trust savings
Bed Closure plan
Reduction in excess bed days
11Slide12
Delayed Discharges
Length of StayExcess Bed daysReduction in bed days lost due to delayed discharges from 3 months to 4 weeksReduction in Length of Stay by 1 day for Medicine and 0.4 day in Surgery on average
15% reduction in excess bed days compared to increase by 8% in similar size Hospital with similar demands in the area
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Emergency
09/10
10/11
11/12
09/10
10/11
11/12
09/10
10/11
11/12
09/10
10/11
11/12
ALL
6.4
5.3
5.6
5.6
5.4
4.9
5.9
6.0
5.1
5.9
5.9
5.2
Medicine
8.6
7.1
7.0
7.8
7.8
6.4
8.0
8.0
6.3
8.1
8.16.7Surgery6.96.06.76.05.75.36.67.06.15.96.55.2
12Slide13
677 patients supported in 6 months
30% of patients supported by the Virtual Ward for Long Term Conditions management94% of surveyed Virtual Ward patients felt they benefitted from the service87% felt more confident to manage their Long Term Condition
68% of patients discharged from Intermediate Care without ongoing support
0.6% of cohort re-admitted
16% requiring ongoing care package from Social Care
85% of patients still living independently at home 91 days post Discharge (NI 125)
‘Discharge to Assess’
Re-admissions
Independence
13Slide14
‘Right patient- Right bed’
Estimated Discharge Date compliance from 43% to 96%Less inter-hospital transfersAhead of Deep Cleaning Programme
Increased Qualified Nursing levels on the wards
25 Discharges a week compared to 6-7 to bedded unit
Estimated Discharge Dates
Deep Cleaning
Reducing Variation
14Slide15
Lessons Learnt
Project Manager role invaluableConsistent message regarding ‘Discharge to Assess’ at all levels (standardised presentation)Partnership Board and Emergency Care Board scrutiny and endorsement Evaluating outcomes across organisations regularly and early on, managing the changes in bed useCommissioning support regarding contracting and performance 15Slide16
Ahead of Deep Cleaning Programme
Increased Qualified Nursing levels on the wards25 Discharges a week compared to 6-7 to bedded unitEstimated Discharge DatesDeep CleaningReducing Variation
16Slide17
Electronic Common Assessment Tool developed between Health and Social Care
Critical success measures openly shared between organisationsTwice weekly Tele Conference between Health and Social Care to ensure patient flow in Community
Automating Navigation
Shared data
Community Flow
17Slide18
18