Improving discharge times across an integrated health and care system
How we brought efficiency to Durham’s integrated health and social care system
CHS Healthcare was commissioned to help improve patient flow throughout Durham’s integrated care system
Over the first year, CHS Healthcare helped efficiently discharge more than 500 patients from hospital, moving them into the right care for their needs
As a result, the integrated system’s Delayed Transfer of Care days were reduced by 60%
The County Durham Care Partnership is made up of County Durham and Darlington NHS Foundation Trust, Durham County Council, County Durham CCG, and care homes. The partnership has been working together in an integrated patient flow improvement programme comprised of several initiatives, including ‘Teams Around Patients’, which is a crisis response service in the community aimed at avoiding hospital admissions. The teams also identify people already in hospital as well as those likely to head into hospital who could be better supported by the community services, such as rehabilitation beds available to them.
Through ‘Teams Around Patients’, a reablement initiative has also been implemented. This provides short-term rehabilitation for inpatients, after which a view is taken on whether a care package is needed. The aim of this is to support people so that a long-term care package is not required.
In November 2018, CHS Healthcare were commissioned to help the County Durham Care Partnership achieve its objectives of becoming a more integrated system, specifically through patient flow. CHS’s role in the system would also help the partnership to achieve the priorities set out by the NHS on Discharge to Assess and Delayed Transfer of Care. These objectives were achieved by CHS facilitating and coordinating complex care home placements of patients funded through Continuing Healthcare, the Local Authority, or self-funding.
CHS Healthcare works with organisations across England supporting patient flow projects and was able to bring this extensive experience to support the County Durham Care Partnership.
Paul Copeland, Strategic Programme Manager (Adult and Health Services) Integration at the council, said: “There has been recognition across the whole system that CHS Healthcare is providing a highly valuable service which is contributing to the improvements we are seeing.
“The fact they’re so responsive means we are able to support local people find the most appropriate care very quickly.
“The way the CHS team has built and maintained relationships across the Durham health and care system is a credit to their approachable and responsible nature. These relationships have been key to their successful integration, as the team can easily interface with colleagues in the NHS, social services and care homes. The team are very well respected and appreciated, both strategically and operationally.” From November 2018 to November 2019, CHS Healthcare has:
- Helped 543 patients find care in the community
- Discharged patients in a median time of two days and four hours
- Received ‘excellent’ or ‘very good’ feedback from 97% of patients
Before CHS became involved, between November 2017 and October 2018, the average number of delayed days per month was 265. In contrast, between November 2018 and October 2019, after CHS began coordinating placements, the average number of delayed days was reduced to 106, which represents a reduction of 60%.
Since November 2019, CHS has placed another 765 patients. The council has also looked to further build on the successes driven by CHS Healthcare and has implemented a trusted assessor service, where a dedicated clinician undertakes care home assessments on behalf of the care homes and hospitals. This service has brought further success to the integrated partnership which can be seen in the reduced speed of service as well as the 60% reduction in Delayed Transfer of Care. On top of this, it has helped the County Durham Care Partnership further achieve integration with 93 of the 96 care homes signing up to this service.
This service has assisted the Partnership to achieve its patient flow objectives. Before the service was implemented, the average delay time caused by waiting for a care homes assessment was 18 hours. These delays accounted for 49% of the total delay time. Since the implementation of the CHS service, the average wait time for a care home assessment is now only 2 hours. This has allowed for almost double the placements to be made with a reduction in delay times by more than 50%.
Effective patient flow across an area can only be achieved by partnership working. In Durham, partners have come together to support older people to receive the right care in the right place and the impact has been considerable.