Midlothian Intermediate Care : Sharlotte Patterson
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6EA Learning Workshop October 2019
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Midlothian Intermediate Care : Sharlotte Patterson
- 1. Midlothian Intermediate Care What are we doing differently this winter?
- 2. Who are we?
- 3. Minimise time spent in hospital Maximise a person’s independence and/or ability at home.
- 4. Assessment / Equipment / Rehabilitation
- 5. Referral Criteria 18+ years of age Midlothian resident Medically fit for discharge Able to mobilise and use the toilet independently (+/- equipment / walking aid) AHP assessment not fully completed in hospital Postcode Locator Website - https://www.gov.uk/find-local- council
- 6. What makes us different?
- 7. Our work so far.. •We have supported 185 patients home from hospital. •In total we have calculated an estimated 1360 bed days saved. •We have calculated an estimated cost saving of £419,863.10!
- 10. Questions
Editor's Notes
- We are a team of NHS and Council employed staff Resource Manager who is Social Work background Myself as Team Leader who is Social Work, Mental Health Officer background We currently have two band 6 Physiotherapists (PT) and two band 6 Occupational Therapists (OT) within our team. We also have 8 Community Clinical Support Workers (CCSW). And one Community Care Assistant (CCA). Our service is now 6 months old. We are planning to expand this winter to provide greater capacity by recruiting additional Physiotherapist, Occupational Therapist, Physiotherapy Assistant and 4 additional Community Clinical Support Workers which will enable us to provide 7 day cover.
- Our mission is to minimise time spent in hospital and to maximise a person’s independence and / or ability at home. We aim to reduce the number of delayed discharges and reduce length of hospital stay by getting patients out of hospital as soon as possible in a safe and consistent manner. We recognise and understand that most patients are happier in their own home and often improve more quickly. A report by Dr Juliet Harvey stated that elderly patients in hospital can spend 99% of their day being inactive, which isn’t surprising that around 25% of patients leave hospital with a disability due to low activity levels. When people return home it is estimated that activity levels increase by 10 times. To align with our mission we are currently working on extending our hours as previously mentioned. To ensure that this would make a positive impact we did a Test of Change over a weekend day. This was very successful and we were able to facilitate 2 further discharges, one on Friday (which was a late discharge that we could not see that day and if an AHP was unable to see on the Saturday would have had to stay in hospital until the Monday) and a further discharge on the Saturday. Our team was also able for work closely with Hospital at Home during the weekend to provide extra support for a client who we were advised didn’t need our input but became evident on the Saturday that they did. This ensured a good outcome for the patient.
- We carry out PT and OT assessments on the day of discharge We can look at mobility, transfers, self care, kitchen tasks and medication management. We can also carry out cognitive assessments. We can issue any equipment that is required. During the first visit we set rehab goals with timescales and agree on a Support Plan if necessary. We also complete the Bartel Index as an outcome measure and complete this again on discharge from the service. We have CCSWs that can support short term (approx 2 weeks) up to three times per day following a Reablement model. They work from half past seven in the morning to 8 in the evening. We use a banding system. Band 1 – 0730-1130 Band 2 – 1200 – 1500 Band 3 5-7.30. We can also support patient’s home jointly with our Hospital at Home Team in Midlothian for those who have outstanding medical needs.
- We carry out daily screening of all Midlothian patients admitted to RIE, WGH & MCH. We then identify any potential D2A candidates and flag them up to therapists via email or by writing a note on Trak to prompt the teams to consider us for supported discharge. We are always happy to receive calls to discuss referrals and to highlight any relevant information that we should know about. We have a referral document that you can fill in and over to our mailbox. Alternatively call and we can take the referral over the phone if you are particularly busy. We ask that the patient is given our patient information leaflet before leaving hospital. We request AM discharge to allow us time to get out to see them on the day of their discharge, unless patient’s are safe to wait until the following morning.
- So what is it that makes us different? We’re unique in that we are very much an integrated team. We have a mix of staff that are employed directly between NHS and Midlothian Council. We are also co located with other Midlothian Council teams, this enables us to have a close working relationship with in reach social workers, and our flow hub who manage Midlothian patients in hospital. We therefore have excellent links with our care at home service and in the rare case that a package of care might be required for a patient we are able to have those conversations quickly making the service streamlined and for the patient. Whilst the team are not lead by an AHP I have excellent links with leads. In fact an office with the physio team lead. My leadership style is about giving autonomy to my staff, I encourage them to explore and trial things to make sure they are right and make sure that the service is right for us as well as the patients and for us not be a carbon copy of other services. Health care changes constantly and we have to ensure we don’t get stuck in a rid but instead that we are able to flex and change when necessary. I feel strongly about promoting leadership in my team and encourage them take ownership of the service and not be afraid to question why. They are the staff on the ground and it is important that they are able to have a voice in service development and that is doesn’t come from the top down.
- We have been supporting patients home since 18th March 2019. We are driven to support 5 MOE and 5 Orthopaedic patients home each week. We have supported 185 patients home from Royal Infirmary, The Western General, The Astley Ainslie, Midlothian Community Hospital and from Highbank (our intermediate care facility) This has meant a staggering 1360 bed days saved Which is an estimated cost saving of £419,863.10 – based on the cost of a bed in the ward that the patient has been discharged from. We have based our calculations on the level of therapy input from AHPs. If the patients’ weren’t receiving the intense therapy they would not have been able to have been discharged. The AHPs will then assess when the client has reached the level that would have been able to have been discharged from hospital. There may be further requirement for ongoing rehab from the team but this would not be counted in terms of bed days saved as this would have been something the patient would have received in the community.
- As you can see we take from a range of disciplines, our main work streams are MOE and Ortho but we do take from others when we have availability. With our expansion of a larger team we are planning to develop a stroke pathway for Midlothian in the near future as well as being able to offer more of a dedicated service outside of Orthopaedic and MOE wards.
- We have a team Twitter page which we are using to provide team updates and also link in with other Health Boards, teams and professionals. Please follow us; @MidD2A
- Any Questions?