Uko Umotong, Hospital Discharge & Community Services Manager
We know that efficient discharge and patient flow are especially critical at the moment given the ongoing pressures on the NHS and social care and with a “new normal” potentially on the horizon.
To open the discussion around how this can best be managed, we recently held the fifth session in our ongoing webinar series, “How can data support better discharge management?” Here we heard from Lisa Duncan, Urgent Care and Senior Operations Manager at Staffordshire and Stoke-on-Trent CCGs, as well as Kate Tatton, Business Manager (Midlands) at CHS Healthcare.
We discussed the ongoing challenges in discharge management, and how data can be used to overcome them. With the example of CHS’s dashboard, we were able to highlight how an integrated management system can play an important role in this process, as well as planning for the future.
Overcoming challenges in discharge management
Some of the main challenges in discharge management include:
- Understanding real-time demand for services and patient status
- Having to consult multiple reporting systems for information and lack of interoperability between them
- Managing flow through Covid-designated spaces
There must be an understanding of where patients are in the system, how they are moving through it, and how this fluctuates. The best way of achieving this is through access to real-time, system-wide data. We heard from attendees that nationally, people across systems and job roles find it challenging to access the information they need when they need it. Accounting for additional Covid-19 requirements like designated spaces is incredibly difficult without this.
Where this data is available, it allows users to look at specific areas requiring attention, as well as being able to step back and look at the system more holistically to understand the impacts that activities in specific areas have on one another.
Informing diverse stakeholders
The Covid-19 pandemic has undoubtedly furthered partnership working. Given the volume of patients moving through health and social care systems and the necessary pace, there is a need for a collective way to manage the data that are critical to the oversight of this process.
Discharge processes often occur in silos, despite there being several stakeholders across health and social care involved in the patient journey. Different stakeholders will need different types of information, so we need a system that caters for this. This could include:
- Bed occupancy in acute settings and in the community, as well as insight on where fluctuations may be coming
- Where patients are at a given time, how long they have been there, where they have come from and where they are going
- Infection control in the community (such as outbreaks in care homes) and how this will impact the wider D2A system
- Opportunities to involve other partners like mental health services
CHS’s Discharge Pathway Analytics
CHS has developed a web-based dashboard that houses all of the above information, accessible in real time. The dashboard is access-led so all stakeholders only access what they need and is relevant to them.
Using data and insights to plan for the future
From this information we can draw insight, which is incredibly valuable for ongoing decision making as well as evidence-informed future planning. The partnership working facilitated through a system like CHS’s dashboard allows stakeholders to move past the step of needing to collect and collate information to instead focus on what comes next given what they already know. The consequences of this are far-reaching, especially in planning and commissioning.
With the transition to Integrated Care Systems, this level of connectivity will be crucial, allowing a system to understand where gaps lie, where investment needs to be made, and how efficiencies can be enabled. At the local level this also means services can be strengthened to meet needs that will vary across and between populations and fluctuate over time. This oversight will also be key to admission avoidance and understanding if existing pathways are correct for different patients.
During the session we received questions on the follow topics, both in relation to CHS’s Discharge Pathway Analytics and data supporting discharge management.
How do we balance sharing data appropriately but openly, and ensuring the right people have access to the right information? What reporting is available?
Data sharing is an ongoing issue, especially given the number of different organisations and sectors involved in hospital discharge. CHS’s dashboard provides an example of where having data housed and updated in a centralised database allows for real-time information to be extracted from the highest to the most granular level. As it is access-based, there are assurances that everyone who needs oversight has this and sees only the information that is required for their decision-making processes.
In order to offer valuable insight, platforms need to have a reporting function that allows a user to look at discrete snapshots as well as trends, and to allow people to build their own reports based on their needs. CHS’s system shows real-time data and updates every 15 minutes. It can also be set to give you a snapshot report at a specific time, in line with any internal reporting requirements.
How can a data management system be used to account for requirements due to Covid-19, such as testing status and management of designated settings?
Because a system like CHS’s dashboard houses its data in a central database, it can store data specific to Covid-19 such as testing status. This can be accessed on both an ad hoc and a real-time basis. Covid-designated settings are an example of where clear oversight of bed occupancy and length of stay are especially important.
We have 3 local authorities, 1 community nursing partner, 2 acute hospitals, 3 community hospitals, 13 PCNs – would it be possible to use this tool across this entire footprint?
A system like CHS’s would be beneficial to disseminate information through this system and allow for proactive planning.
How can we ensure as trusts that we are working in the same process?
Data held within the database will support process planning and performance metrics will allow trusts to measure consistency and alignment. Data integrity is key here – data entry is accurate and reliable ensuring output can be trusted.
A recording of the webinar is available here.