Home to the unknown: getting hospital discharge right

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:

  1. 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.
  2. 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.
  3. 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).
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Reducing long hospital stays

Guide to reducing long hospital stays|  NHS Improvement

hospital-1806111_1920 (1)Nearly 350,000 patients currently spend over three weeks in acute hospitals each year. Many are older people with reduced functional ability (frailty) or cognitive impairment. The benefits of reducing hospital bed occupancy are clear, but achieving it has proven difficult, particularly during winter.

This guide details practical steps to implement approaches to reduce length of stay. It is primarily aimed at acute and community trusts, but also makes reference to how system partners can play a supporting role.

Full document: Guide to reducing long
hospital stays

Additional link: NHS England press release

New approach to NHS clinical assessment could save thousands of lives

NHS England is asking every hospital trust to adopt the Royal College of Physicians’ new clinical assessment system, The National Early Warning
Score (NEWS) 

The National Early Warning Score (NEWS) has been produced by the Royal College of Physicians and is backed by the Royal College for Emergency Medicine, NHS Improvement, the Association of Ambulance Chairs and Sir Bruce Keogh, National Medical Director for NHS England.

The system was developed by the Royal College of Physicians with the aim of creating a standardised approach to clinical assessment across the country.

It is estimated that the NEWS is now being used in over 70% of trusts but NHS England is setting the goal of having the system in place across every acute and ambulance setting by 2019.

Having the NEWS adopted as the standard system will mean NHS staff who move between trusts are using a consistent set of measures for diagnosing patients.

Full story at NHS England

How ward staff engage with the implementation of a patient safety intervention

A patient safety intervention was tested in a 33-ward randomised controlled trial | BMJ Open

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Objectives: No statistically significant difference between intervention and control wards was found. We conducted a process evaluation of the trial and our aim in this paper is to understand staff engagement across the 17 intervention wards.

Findings: First, there were palpable differences in the ways that the 17 ward teams engaged with the key components of the intervention. Five main engagement typologies were evident across the life course of the study: consistent, partial, increasing, decreasing and disengaged. Second, the intensity of support for the intervention at the level of the organisation does not predict the strength of engagement at the level of the individual ward team. Third, the standardisation of facilitative processes provided by the research team does not ensure that implementation standardisation of the intervention occurs by ward staff.

Conclusions: A dilution of the intervention occurred during the trial because wards engaged with Patient Reporting and Action for a Safe Environment (PRASE) in divergent ways, despite the standardisation of key components. Facilitative processes were not sufficiently adequate to enable intervention wards to successfully engage with PRASE components.

Full reference: Sheard, L. et al (2017) Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation. BMJ Open. 7:e014558