Case Study

Hospital Discharge in Lancashire

LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST

Sara Derbyshire is General Manager, Emergency Medicine, at Lancashire Teaching Hospitals NHS Foundation Trust. CHS Healthcare has been running a home of choice discharge scheme for the trust since April 2012. The six-strong CHS Healthcare team supports an average of 30 patients a month who need to transfer from hospital beds to care home of choice.

“From an audit that I undertook between August to October 2011, it was clear that home of choice patients formed a significant part of the delayed transfers of care within our hospital. The audit data measured the home of choice process, starting from the time the patient is identified as needing 24-hour care, generally by a social worker, the funding stream identified and relatives informed of the type of care home placement required.

“Taking this as the starting point, the audit demonstrated an average of 16.2 days before discharge took place. It was not difficult to understand why this significant delay was happening – in reality, we were presenting families with a list of over 100 care homes to choose from; it must have been truly overwhelming for them.

“With the best will in the world, our staff are just not able to give the patients and relatives as much support as they needed to find a suitable home. Some became really overwhelmed with the number of homes they might need to consider, some didn’t have their own transport to physically get to visit the care homes and a small number of relatives became disengaged from the process all together.

“At our initial meeting, CHS Healthcare were confident that they could reduce the number of bed days significantly from this average of 16.2. I set us a target reduction of four to seven days, but even in the first month, there was an immediate impact, and the average number of bed days in this process reduced by 10.

“CHS Heathcare focus exclusively on this patient group which our staff are not able to do. They really go the extra mile for patients, relatives and carers. For example, there was an elderly patient who did not have relatives, but really wanted to choose his own care home. CHS staff contacted the Red Cross and arranged to borrow a wheelchair so that they could take him to see homes for himself. Two of the girls got permission from the ward team and took him out in their car to view the home. He has settled in really well, having been able to make a personal choice of where he wants to live – that’s so important in such a life-changing decision, and I feel by supporting patients to make decisions in this way, we are ensuring that they remain in control of their life and their care.

“I genuinely now see the CHS team as an extension of my team – right from the outset they fitted in really quickly. Without a doubt, there has been a positive impact since the scheme began. Like most organisations now, we have been through a number of service reconfigurations including bed reconfigurations, and whilst other initiatives have also played their part, undoubtedly CHS Healthcare have played a pivotal role in helping us by ensuring our beds are more appropriately used.

“But the benefits are not just financial. I feel that before we had CHS Healthcare, we were doing a disservice to our patients in some ways. Many became overwhelmed by the choices and having to make such a difficult and important decision. At the same time, we were asking them to come to that decision as quickly as they could, so it is likely that they would feel somewhat pressured.

“CHS Healthcare handle this very well – as an independent party they explain that the transfer needs to take place efficiently, but throughout the process they are providing whatever support is necessary. CHS work with families to identify what is important to them – this might be having a home located near a particular transport route, one with good outside facilities or a good programme of activities. By focusing on what is key to the individual, they quickly narrow down the choices to a realistic number, so they are looking at homes most likely to suit the individual.

“CHS Healthcare advisers are independent and will not recommend any individual homes, but they will feed back observations during visits, for example something which resulted in a family not choosing a care home. By communicating this back to care homes, I feel that they are able to influence and improve standards and quality within homes.

“My overall view on CHS Healthcare is very simple – it is a ‘win win’. It’s a very simple but extremely effective service. The team are supporting families through an enormously emotive and challenging time. Just as we want patients to be able to have access to hospital care when they need it – the right care in the right place at the right time – we also want their discharge to follow exactly those same principles; we want it to be a smooth, supported process that is as ‘stress-free’ as possible. The benefits are very clear – CHS Healthcare have surpassed our target for reducing the delays associated with this patient group AND we have improved the quality of care we provide to our patients. In short, for me, it’s a ‘no brainer’!”

UPDATE: MAY 2014

Figures have now been collated for 12 months up to April 2013. These show the time from referral to transfer to care home have further reduced and are now 6.88. This means bed days per patient have now been reduced by 9.32 per patient. During the 12 months up to 2013, we supported the care home selection and placement of 567 patients.