Uko Umotong, Hospital Discharge & Community Services Manager
Government guidelines request that NHS and local authorities ensure a 14-day isolation period for patients discharged from hospital into the community. As has been reported recently there are a limited number of beds designated for this purpose, which is why it is important that existing capacity is managed closely to deliver consistent and efficient patient flow. At the same time, we must provide a safe and reassuring experience for patients and their families.
We recently held our fourth session in our ongoing webinar series, “Managing safe discharge and Covid-designated spaces this winter”. Joining the webinar were guests from across NHS trusts, CCGs and local authorities. We were pleased to be joined by Natalie-Jane Macdonald, CEO, Sunrise Senior Living and Tina Snowdon, Area Manager CHS Healthcare to discuss the importance of efficient tracking and management of Covid-designated spaces under the new government guidelines this winter.
The challenge of designated settings
Speaking from her first-hand experience of seeing how Covid-designated settings were being handled and implemented, Tina noted that the process has been hindered where a “one size fits all” approach was taken, and that contextual insight is critical for each setting.
As Covid-designated spaces are allocated, the primary blockers to efficient patient flow and correct implementation include the number of beds and space of the care provider, test results not coming back in a timely fashion, as well as simple lack of clarity regarding the next steps. People are often unsure of what is happening next and lack the necessary information required in determining whether a patient is ready to move on and where they need to be going.
Furthermore, as Natalie noted, designated settings are a good idea but for certain patients, such as someone with cognitive impairment, going to hospital in the first place is a hugely traumatic experience. To then move somewhere else – where they have likely never been – to be looked after and then to move again can cause significant deterioration in their level of functioning. “Our Sunrise or Gracewell home is our residents’ home. We have to be able to welcome them back from hospital whatever their status is,” she said.
Tracking and oversight are critical for safe discharge
At the time of the webinar, the latest CQC data on Covid-designated settings and the South East showed that 1,500 beds had been provided by local authorities for use as designated beds, but only 141 of them were approved for use by the CQC. With a limited number of beds, we need to be able to know who is where at any given time and what their care needs are.
We are currently working well with the D2A model and designated discharge settings. “If we know where a patient is going before they leave hospital and we know that they are there for two weeks, then we can be planning while they’re in hospital, before they go to their designated discharge setting, and identify where they need to be going onwards from there. The flow has already been mapped before they leave hospital,” noted Tina. There have also been successes in using available hospital wards for the 2-week isolation period to avoid the use of an additional separate setting, though this is again subject to bed availability.
Discharge planning should start at admission and this imperative doesn’t change because of Covid-19. “It is critical that we are using beds efficiently, ensuring tight tracking, making sure plans are in place and that everyone involved is aware of what is going on, including a patient’s family. When we pull these facets together, we can really have a slick and swift operation while ensuring as minimal impact to the patient as possible, as the patient is at the forefront of all our minds,” noted Tina.
When asked about the current state of play, both Natalie and Tina agreed that it is essential to recognise that everyone is experiencing the same level of uncertainty, noting that each person and every organisation has a role to play in supporting care at this time. While it is critical to reduce and prevent infection, organisations must be focussed also on doing their utmost to maintain quality of life for patients and their families, for the limited time they may have together.
Looking ahead, the best way forward is to ensure clear and efficient communication amongst all partners, recognising that together we are able to cope with the challenges posed by the pandemic. Placing patients’ needs at the forefront of decision-making and efficiently implementing detailed planning and tight tracking of a patient’s journey through the system is the basis of effective patient flow.
As Tina concluded, “This year we have seen the ability for people to adapt and to pull together and work together and implement things that they never believed they could do”. This is the energy we need to continue with in the year ahead.
CHS Healthcare has been supporting CCGs with hospital discharge pathways nationally for 25 years and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact firstname.lastname@example.org to discuss your needs.
You can access a recording of the webinar here: https://chshealthcare.co.uk/events/webinar-managing-safe-discharge-and-covid-designated-spaces-this-winter/