Discharge to Assess South Gloucestershire & Bristol: Pathway 1

A programme to improve discharge from acute hospital through 3 pathways

 To home with support (Pathway 1);

 To a nursing or care home facility (step down bed) with rehabilitation and reablement (Pathway 2);

 To a nursing or care home facility with recovery and complex assessment (Pathway 3).

Drivers and benefits of Discharge to Assess

 Improving the service user experience – enables ongoing assessments to be done out of hospital in the right place at the right time – makes assessments more meaningful for the patient;

 Ensuring that service users receive the right care at the right time in the right place;

 Preventing unnecessary long stays (LOS) in the acute trust, hence ensuring ‘patient flow’ and allowing unwell patients to easily access acute care at the ‘front door’ (emergency zone);

 Preventing secondary complications of an extended hospital stay;

 Needing simpler discharge and referral processes – ‘Releasing time to care’;

 Requires less assessments and/or interventions in acute hospital setting.

In South Gloucestershire all three pathways were piloted over the course of 2014-15 and from these it was clear that Pathway 1 had the greatest potential to significantly reduce LOS of patients and support the Acute Provider to achieve their 4 hour ED targets. The pilot also highlighted some of the possible benefits to the local health system over its 3 month period:  Total number of bed days saved – 62;

 Total bed costs reduced by £153,000;

 Significant shift of workload into the community;

 Significant impact on SG Local Authority OT technician service noted;

 On-going operational issues noted including identification of appropriate patients in a timely manner/clear guidance for staff on wards/timely dispensing of TTOs/Allocated transport slots and timely discharge from wards.

From 2nd September Pathway 1 was rolled out across all wards.

In Bristol a soft launch of Pathway 1 commenced in late July and has allowed for adjustments and tweaks over the autumn months to ensure it is running smoothly. There has been close working with Bristol City Council to ensure sufficient capacity in homecare with £1 million investment in homecare and £1m BCF investment in the STAR reablement service. Bristol City Council has a new homecare contract being rolled out from August 2015, which includes a “no refusal clause”, requiring providers responsible for each Bristol homecare “zone” to take all packages referred to them (sub-contracting arrangements will be in place). Once fully operational, this model will deliver a zero wait for packages of care.

Important partner involvement to the success of the project:

 Social Care & Community health involvement in designing new ways of working;

 Capacity modelling using data from all partners to forecast demand and capacity requirements;

 Sharing of system information imperative to the efficiency of the IDS;

 Management and operational level buy in and involvement.

Important considerations and questions to be asked to determine pathway for patient

Pathway 1

 Is the patient ‘safe between visits’?  Can this person call for assistance? Can they use a phone? Is there a piper lifeline? Is there somebody present in the home?

 Does this person need to transfer? If so how is this managed? With or without assistance?

 Is there a falls history? Does this person need to use stairs? Can a bed be accommodated downstairs?

 Can this person access the toilet or a commode? What continence needs do they have? Are there pads or a commode in place?

 What are the night time needs?

 May have known periods of confusion, that can be safely managed at home.

 No evidence of aggressive or challenging behaviour.

 If you consider that the patient need a meet and greet, call the Rehab Coordinator to discuss.

 Does the patient need a night sitter? (criteria includes continence needs, assistance getting in and out of bed).