This research explored patients’ unplanned stays in hospital and what it was like for them after they had returned home | British Red Cross
The research sought to reveal: patients’ experiences of being discharged from hospital; hospital systems and healthcare professionals’ experiences and perceptions of the discharge process; and what it was like for people returning home from hospital feeling more or less prepared.
As a result, it aimed to explore the impact of discharge on recovery and wellbeing and to identify opportunities to improve systems, communication and support.
Based on the experience of the British Red Cross and the research, the report argues:
- There is a substantial opportunity for commissioners and providers to harness the power of non-clinical support, including the voluntary and community sector (VCS), to relieve the pressure on the NHS and to create better outcomes for people and improved patient flow within and between health and social care providers.
- Every point of hand-off between clinical teams in hospital and from the hospital to the community is a potential point of success or failure for patient recovery. The report recommends that there is a clinical responsibility to ensure the effective management of these transitions, so that there is continuity of care and patients don’t fall through the gaps between teams.
- The report recommends that a five part ‘independence check’ should be completed as part of an improved approach to patient discharge – prior to discharge or within 72 hours of going home. This would help to inform the setting of a realistic discharge date and would include assessing:
- Practical independence (for example, suitable home environment and adaptations)
- Social independence (for example, risk of loneliness and social isolation, if they have meaningful connections and support networks)
- Psychological independence (for example, how they are feeling about going home, dealing with stress associated with injury)
- Physical independence (for example, washing, getting dressed, making tea) and mobility (for example, need for a short-term wheelchair loan)
- Financial independence (for example, ability to cope with financial burdens).
A new specialist service in South London is bringing together housing, clinicians and discharge teams to work with patients whose housing problems are delaying their discharge from hospital | NHS Confederation
This briefing reports on a a new specialist service based in Croydon, South London. The service supports patients to move on from hospital to either supported living, the private rented sector, council properties or hostel accommodation. They are helped to access funding, legal advice, benefits and other services.
Insecure housing is often cited as reason for patients being admitted to hospital. The Crisp report (2016) found that 16 per cent of patients on acute wards were delayed discharges, and that 49 per cent of these patients could not be discharged due to a lack of suitable housing. In response to this, South London and Maudsley NHS Foundation Trust commissioned a new specialist service to be based within Bethlem Royal Hospital to work alongside clinicians and the current discharge team.
Since launching in February 2017, more than 200 patients in Croydon have been supported with housing, which has allowed them to leave hospital quicker.
Full briefing: Helping to address delayed discharges in South London: the HAWK/SLaM service
This quick guide demonstrates how NHS emergency care, in particular patient flow through the health and care system, benefits from allied health professionals | NHS Improvement
Bringing the AHP workforce into patient flow planning can improve quality, effectiveness and productivity.
Each section gives a brief overview of the contribution that AHPs have made to deliver safe, effective patient care and flow, followed by case studies which demonstrate how AHPs:
- work in the community keeping people safe and well at home
- ‘front door’ assess, diagnose and treat patients in emergency departments, ambulatory care and assessment units
- support avoidance of hospital admission
- enable early rehabilitation and reducing overnight admissions
- drive ‘Home First’ (discharge to assess) to avoid in-hospital deconditioning of frail, older people.
Full detail: Quick guide: allied health professions supporting patient flow
NHS Improvement has written to the chief executives of all trusts providing community services setting out actions they must implement to reduce delayed transfers of care over winter. | NHS Improvement | HSJ
NHS Improvement chief executive Jim Mackey has said trusts must help improve delayed discharges over winter and listed six actions they need to carry out in the next six months:
- Facilitate the sharing of patient data with acute and social care partners and from 7 November ensure daily situation reports are completed “to enable better understanding of community services at a national level”.
- Jointly assess discharge pathways with local partners including “being an active participant in the local acute provider’s discharge and hosting operational discussions daily where necessary to discharge patients in community settings”.
- Develop “discharges hubs” over the next six months and beyond, designed to be a single point of access for patients moving between acute and community services.
- Ensure a “robust patient choice policy” is implemented.
- Clarify to partner organisations what services the trust offers to patients.
- Ensure collection of patient flow data and data on plans to improve patient flow.
Full detail is given by NHS Improvement who have produced the following report to help improve flow into and out of community health services:
Flow in providers of community health services: good practice guidance
Related HSJ article: Trust chiefs given new instructions to tackle winter DTOCs
NHS Confederation, June 2017
This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care. Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.
Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.