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Discharge to assess
- 1. A Practical Workshop Describing the Operational Running and Reality of Discharge to Assess (D2A) Cheryl Eyre Integrated Pathway Manager for Active Recovery cheryleyre2@nhs.net
- 2. Objectives of the session • Introduce the “Discharge 2 Assess” Model developed with Social Care colleagues • Explaining how services and workforce have been empowered by providing an environment for innovation and the freedom to try out ideas building a no blame culture • Lessons learned and Recommendations
- 4. STH Facts and Figures • Foundation Trust on 5 sites with 1,100 beds • 2nd largest Teaching Hospital in the UK • Major Trauma Centre and Regional specialities • 1 CCG! • Integrated Hospital and Community Services • Social Care provided by Sheffield City Council • Separate Mental Health and Children's Services
- 5. Integrated Care in Sheffield Integrated care as experienced by our patients
- 6. Integrated Structure • Community and Hospital Services within a combined acute and community care group • Community services include District Nursing, Integrated Therapy Teams and Active Recovery • Acute Hospital Services in the group include acute AHP services, GP collaborative and Palliative Care • Professional Leads recognised and embedded into the structure • Integrated Pathway Managers across the care group to facilitate creative joined up solutions
- 7. Active Recovery One service delivered by two providers:- CICS and STIT ‘Health and Social Care working in partnership’
- 8. Active Recovery Aims • Prevent unnecessary hospital admission • Promote ‘Discharge 2 Assess’ • Facilitate early discharge from hospital • Prevent avoidable admission to long term care • Provide time-limited recovery, support and/or rehabilitation in a persons own home
- 9. Change ‘Assess to Discharge’ To ‘Discharge 2 Assess’ D2A
- 10. The Big Room (Oobeya)
- 11. Big Room – starting with a patient story
- 12. Let me introduce ‘George’ •82 years old •Lives independently and wants to continue doing so •Widowed 5 years ago •Has mild dementia •Daughter lives locally •Losing weight + poor mobility Plan-Do-Study-Act cycles of continuous improvement
- 13. The work so far • Building relationships with hospital based colleagues • Challenge historical practice • Developing Active Recovery processes to support rapid discharge
- 14. Building Relationships • Big Room meetings • Active Recovery therapists in- reaching in to the wards • Shadowing • Test of Change • Developing a no blame culture
- 15. Changing Historical Practice •Changing mind set of medics, ward staff, relatives, Patients and Carers •Reviewing expectation •Referral date = Discharge date
- 16. CASE STUDY MB Introduction Mrs B lives alone in sheltered accommodation, she is 82 years old. She has memory problems and a history of depression. Her two daughters live locally and have Power of Attorney over her finances. Mrs B’s daughters report that they have been struggling to support Mum since her recent deterioration in her health. Mrs B was diagnosed with carcinoma of the colon in the last month and has been losing weight and feeling unwell. On the 16th August 2016 her daughters contacted the GP stating that they were struggling to manage her and that Mrs B had calf pain and was suffering with shortness of breath, she was immediately admitted to A&E with a suspected DVT. From A&E Mrs B was admitted to a care of the elderly ward and diagnosed with an acute DVT, once the medical management of her DVT was completed she was referred to Active Recovery.
- 17. Case Study MH Introduction Mr B is a 78 year old gentleman with a significant cardiac history. He was referred to the Discharge 2 Assess pathway following a 17 day admission with atrial fibrillation. Prior to the admission Mr B was able to independently meet own Activities of Daily Living (ADLS) but was experiencing pain from hip area and was awaiting a total hip replacement.
- 18. Benefits for the patient • Reduced length of time in hospital. • Less likely to contract hospital acquired infections. • Less time to become institutionalised • Less likely to lose confidence re-mobility • Return to familiar surroundings • The assessment for on going support, if required, takes place in own home
- 19. Benefits for the organisation • Reduction in bed occupancy • Reduction in length of stay • Reduced pressure on beds • Improved flow • Saves money
- 20. Time waiting for discharge to AR
- 21. Time waiting to get home per patient D2A starts
- 22. D2A starts 7 day reduction in length of stay
- 23. Lessons learned/Recommendations • Service Improvement techniques/expertise • Genuine Consultation with staff • Joint design with a grounded collaborative approach • Assume ‘spread’ with caution • Patient involvement and experience at the heart of any change
- 24. “It’s changed the way we think” ‘Discharge 2 Assess’
- 25. Any Questions Thank you Cheryl Eyre Integrated Pathway Manager for Active Recovery
Editor's Notes
- This describes the development and delivery of a bold vision for the joint health and social care provision of Intermediate Care services in Sheffield. These services are required at times of crisis or significant change in a person’s circumstances which impact on their ability to stay or return home and are delivered at a point when patients and their carers are most vulnerable. The Intermediate Care Services being delivered in Sheffield have historically operated independently, resulting in different approaches to service delivery and a potential missed opportunity for patients to benefit from the skills and knowledge of staff in both services. The Community Intermediate Care Service (CICS) was commissioned by Sheffield CCG to deliver a time limited interdisciplinary service for patients. The focus is rehabilitation and re-enablement delivered through an interdisciplinary team which includes skilled Nursing, Physiotherapy, Occupational Therapy, Community Geriatrician, Pharmacy, SLT, Dieticians, Rehabilitation Assistants and Admin staff. The Short Term Intervention Team (STIT) is a social care and reablement service provided by Adult Provider Services in Sheffield City Council. STIT helps people to regain their abilities or confidence in maintaining their independence, so they can continue to live in their own home or return home more quickly after a period in hospital; with support to recover in the home environment. A development programme to bring together the National Health Service (NHS) and Local Authority (LA) care support workers through aligning operational processes, skills training and joint paperwork has been undertaken. Although still separate organisations (LA and NHS) the shared vision and partnership working has meant significant changes around processes and service models to create an effective, single operating model.
- Frail older people should only be admitted to hospital only when there is evidence of life threatening illness or need for surgery. Discharge to Assess as soon as the acute episode is complete. Provision of comprehensive assessment during post acute care to determine and reduce long term care needs.
- The definition of the ‘Big Room’ the concept comes from that used by Toyota. During the product and process development, all individuals involved in managerial planning meet in a "great room" to speed communication and decision-making. The Obeya can be understood as a team spirit improvement tool at an administrative level. The facility allows for greater flexibility in creating a tailored product for Toyota, which is strengthened by close contact and coordination. The facility also has an Obeya room where a cross-functional team can come together to solve problems quickly as part of Toyota's Kaizen approach to project management. " ...
- Benefits for patients- Reduced length of time in hospital. Less likely to contract hospital acquired infections. Less time to become institutionalised Less likely to loose confidence re-mobility Return to familiar surroundings The assessment for ongoing support, if required, takes place in own home