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‘Navigating the System’ Finding early opportunities to access Community Services-

‘Navigating the System’ Finding early opportunities to access Community Services- ‘Discharge to assess’ work stream Bie Grobet South Warwickshire Foundation Trust. Warwickshire North CCG challenges. Nuneaton and Bedworth : top 1/3 most deprived areas in England

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‘Navigating the System’ Finding early opportunities to access Community Services-

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  1. ‘Navigating the System’ Finding early opportunities to access Community Services- ‘Discharge to assess’ work stream BieGrobet South Warwickshire Foundation Trust

  2. Warwickshire North CCG challenges • Nuneaton and Bedworth : top 1/3 most deprived areas in England • Warwickshire: 26/37 deprived areas are in Nuneaton and Bedworth • Rural North Warwickshire: 18.3% >65 years old

  3. George Eliot Hospital • District General Hospital • Serves a population of 290,000 • North Warwickshire, South West Leicestershire and North Coventry • 352 beds

  4. Bed based model  Community Team model NHS Warwickshire Bramcote Hospital • 41 bedded Rehabilitation Unit • Reduced to 20 beds 2008/09 • Option appraisal for re-provision 2010 • Closure April 2011

  5. 4 Principles to improve Care for Older People (Prof. Ian Philp): • ‘Choose to admit’ only those frail older people who have evidence of underlying life-threatening illness or need for surgery – they should be admitted, as an emergency, to an acute bed • Provide early access to an old age acute care specialist, ideally within the first 24 hours, to set up the right management plan • ‘Discharge to assess’ as soon as the acute episode is complete, in order to plan post-acute care in the person’s own home • Provide comprehensive assessment and re-ablement during post-acute care to determine and reduce long term care needs

  6. Expansion of Intermediate Care and Virtual Ward Services- Doubling capacity and workforce • Service opening hours: 8.30 am till 12 Midnight • Development of Community Emergency Response capability- 2 hour response • Simplified referral criteria – ‘Discharge to Assess’ • Drive to improve confidence and understanding of Community Services by Acute and GP colleagues • Reducing variation: 5 Daily Discharges- managing Acute and Community flow commitment Simplified access Emergency Capability Reducing variation

  7. ‘Orange’ and ‘Green’ Flow:Bed days for adult emergency admissions 2008/09 Source: Dr Foster Intelligence & NHS Institute (2011)

  8. Early opportunities for 5 patients to be discharged daily • 2 Community Nurses navigating patients to Community Services • Project Manager working across Acute and Community • 2 work streams: ‘Orange flow’ short stay, ‘Green flow’ ward stays • 677 patients supported • Shared data collection to measure success ‘5- A- Day’ Project Community Navigators Project Manager role across Acute and Community

  9. Retraining Community Hospital staff • Change of culture and approach • ‘Hearts and minds’ presentations • Senior Leadership sign up and ‘Can Do’ approach • Ward level engagement in discharge planning • Integrated Emergency Care Board • CCG and Board (x2) support Change management Improving confidence Whole system sign up

  10. Closure of Community Hospital savings - £2.07M: • £1.03 M reinvested in Intermediate Care and Virtual Ward Services • £400k invested in Intermediate Care beds in Nursing Home • £1M of further savings re-invested in Acute contract • 18 Acute beds closed • Winter capacity only opened sporadically Re-investment Acute Trust savings Bed Closure plan Reduction in excess bed days

  11. Reduction in bed days lost due to delayed discharges from 3 months to 4 weeks • Reduction in Length of Stay by 1 day for Medicine and 0.4 day in Surgery on average • 15% reduction in excess bed days compared to increase by 8% in similar size Hospital with similar demands in the area Delayed Discharges Length of Stay Excess Bed days

  12. 677 patients supported in 6 months • 30% of patients supported by the Virtual Ward for Long Term Conditions management • 94% of surveyed Virtual Ward patients felt they benefitted from the service • 87% felt more confident to manage their Long Term Condition • 68% of patients discharged from Intermediate Care without ongoing support • 0.6% of cohort re-admitted • 16% requiring ongoing care package from Social Care • 85% of patients still living independently at home 91 days post Discharge (NI 125) ‘Discharge to Assess’ Re-admissions Independence

  13. ‘Right patient- Right bed’ • Estimated Discharge Date compliance from • 43% to 96% • Less inter-hospital transfers • Ahead of Deep Cleaning Programme • Increased Qualified Nursing levels on the wards • 25 Discharges a week compared to 6-7 to bedded unit Estimated Discharge Dates Deep Cleaning Reducing Variation

  14. Lessons Learnt • Project Manager role invaluable • Consistent message regarding ‘Discharge to Assess’ at all levels (standardised presentation) • Partnership Board and Emergency Care Board scrutiny and endorsement • Evaluating outcomes across organisations regularly and early on, managing the changes in bed use • Commissioning support regarding contracting and performance

  15. Ahead of Deep Cleaning Programme • Increased Qualified Nursing levels on the wards • 25 Discharges a week compared to 6-7 to bedded unit Estimated Discharge Dates Deep Cleaning Reducing Variation

  16. Electronic Common Assessment Tool developed between Health and Social Care • Critical success measures openly shared between organisations • Twice weekly Tele Conference between Health and Social Care to ensure patient flow in Community Automating Navigation Shared data Community Flow

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