Transforming the Discharge Process Carol Jagpal Clinical Manager Complex Discharge Team QEHB
Background Queen Elizabeth Hospital Birmingham has 1400 beds, 32 operating theatres and a100 bed critical care unit It is host to the Royal Centre for Defence Medicine Major Trauma Centre Focus had been on front door with little investment in the management of complex discharges
Why? Discharge Liaison Nurse Team 3 x Band 7, 1 x Band 6 This led to delays in assessment of patients of between 14 21 days except Fast Track DLN team dealing with inappropriate referrals DLN team responsible for DToC information Increase in length of stay and DToC
Why? Social Care Unable to process the volume of Section 2 and Section 5 referrals Delays in Social Worker allocation Inappropriate referrals Increased length of stay and Delayed Transfers of Care
Result Poor experience for patients and families Poor experience for staff Multi disciplinary review seeing the true picture
Solution June 2015 Healthcare Workers (Admin and Nurses) and Social Workers co-located in Discharge Hub with combined rota Clinical manager for Complex Discharge A single Transfer of Care form (TOC) to be used for all referrals (incorporating NHS CHC checklist) completed and visible in Clinical Portal TOC to be completed approx 72 hours before the patient being ready for discharge
Solution (2) TOCs clinically triaged and uploaded within 4 hours All social care assessments further triaged to Complex or Standard Joint assessments Development of Discharge Hub Management System (DHMS) Daily Board rounds attended by health and social care live updated information tracking discharge plans agreement of Notification of Discharge / DToC
Solution (3) Daily tracking of all non-birmingham patients approx 20% of all referrals Recruitment of 3 additional Band 6 Complex Discharge nurses Demand and Capacity modelling identified shortfall in Social work Capacity Development of Complex Discharge Exec panel weekly Implementation of a Bed Utilization policy letters / patient information
Choice Choice in NHS constitution relates to referral choice for elective care not discharge or transfer post acute stay. Patients have to move to interim care if offered or make their own arrangements for discharge. Patients can NOT choose to stay in an acute bed when their needs can be met elsewhere. The overriding determinant is discharge to a place that can meet the patients care needs. We can only offer a choice if more than one place can meet their needs AND has a vacancy.
Bed Utilisation Policy Series of letters Letter 1 given out by team on admission Letter 2 given out when doing TOC Letters 3, 4 and 5 given out under direction of the Discharge HUB
Solution (4) Development of Trusted Assessor role Occupational Therapy team Use of Enhanced Assessment / Discharge to Assess beds Education to ward based teams Delegation of tasks to ward based teams e.g equipment City Wide Housing / Homelessness policy Onsite NEPT staff
On Admission Premorbid function Details of care services pre-admission Provisional length of stay / discharge date What are the barriers to discharge? Bed Utilization Policy Patient Choice Letter 1
During Admission - Questions to ask Is the patient clinically optimised? Does the patient require ongoing rehabilitation services? What is preventing the patient from being discharged now? What is the patient s expectation? What are the goals to get the patient back to baseline? Does the patient require assessment to facilitate discharge?
Hospital Responsibilities Discussion with patient and family Completion of Transfer of Care Referral including NHS CHC Checklist Bed Utilization Policy Patient Choice Letter 2
Outcome Allocation of appropriate assessor Joint working improved experience for patients and families CDN referrals reduction of wait to be seen from 14-21 days to 1-2 working days. Fast Track referrals same day A reduction in DToC - especially assessment delays Joint approach to problem solving with Executive support for difficult decisions
Next steps Development of trusted assessor role On site brokerage health and social care..
Carol Jagpal Carol.jagpal@uhb.nhs.uk 0121 371 4579 Any questions?