November 5, 2020

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Winter discharge planning and developing your D2A pathways

Dr Gabrielle Silver, CEO

Facing both a second wave of Covid-19 infections as well as the winter period, we know it’s critical that discharge pathways are in place to ensure patient flow and safety. 

We recently held a webinar entitled, “Winter discharge planning and developing your D2A pathways”. The purpose was to gain insight into how people are managing the Government’s Hospital Discharge Service guidance issued at the end of August, which gave clear direction on the purpose of D2A pathways to ensure ongoing and efficient patient flow. 

We had almost 200 professionals from hospitals, CCGs and local authorities join this third session in our ongoing webinar series. Dawn Hallam, Discharge Manager, Maidstone and Tunbridge Wells NHS Trust and Kent Community Health NHS Foundation Trust and David Coyle, Chief Operating Officer, The Countess of Chester Hospital NHS Foundation Trust shared their insights on establishing optimal community pathways. 

Optimising the D2A model 

Ahead of the session we polled registrants to understand whether they felt confident that their D2A pathways would be able to discharge patients within the 6-week funding limit. Interestingly, the results were split, and we wanted to gain insight on what is working well, and the challenges people are facing.

To optimise the D2A model, it is vital to continually think about whether someone is medically fit for discharge, and how an intermediate care bed base can continue to support the care of those patients outside of an acute hospital setting. 

Both David and Dawn agreed that it is important to ask questions daily about why patients can or cannot go home on that day, as well as ensuring close collaboration across all systems, including local authority and community partners. Both also noted that it is important to make sure expectations are managed, which means having a solid and functionally aligned operating team. 

Additionally, among care providers there is a nervousness to accept patients who have had a previous positive Covid-19 swab, which is another reason why transparent communication with care providers is hugely important.

The main D2A challenges

We also asked registrants about their main D2A challenges, with the highest response being coordination across health and social care to enable effective flow, followed by getting assessments to take place at the right time. 

Both Dawn and David noted that when the first wave of Covid-19 hit, there was a rush to clear hospital beds. Patients were quickly moved into the community and there was a decrease in both hospital occupancy and referrals. At present, the number of patients is increasing, and there will have also been a significant number of incomplete assessments over the past several months. Given the discharge of high volumes of patients directly to care homes and the time-limited financial support that currently exists for those patients, there must be close collaboration between hospitals, local authority partners and allied healthcare professionals to ensure assessments are completed as efficiently as possible. 

Additionally, as social service team members were instructed to leave hospital at the onset of the pandemic, teams have had to adjust to online working and different methods of communication than would have previously been the norm.

David noted that: ‘’From a D2A perspective, working closely with local authority and community partners is important – there is a higher level of dependency in the community now because people who didn’t come in during the first wave of Covid-19 have deteriorated. There are more pressures now, as we are dealing with a sicker, more frail population. Importantly, we do not have the same access to the care provider landscape because of the need to ensure we are maintaining infection control, which adds further complexity.’’

Dawn noted that: ‘’In the first wave of Covid-19, too many patients were sent out to a bedded solution, when they could have been sent home. The focus is now to firstly ask why a patient cannot go home. Sending patients home should be the first option, because it is the best place for the patient. That will be the shift in how we will deal with the second wave – making sure we have as many people at home as possible.’’ 

Support for D2A and winter planning

We also asked registrants about the support they need most around D2A and winter planning, with the highest response being support with managing capacity. Other responses included the resource to deliver local plans, support with onward care arrangements and restart of CHC assessments.

Coordinators, occupational therapists and physical therapists are vital for facilitating rehabilitation in the community. ‘’A challenge has been getting acute therapists working in the community and not in the hospital setting. Many assessments happenin hospital rather than the community, and this is something we are trying to change’’ said Dawn. 

Hopes for the future

Looking ahead, it will be important to align on a single version of what ‘good’ looks like to manage expectations throughout the discharge process. It is important to keep flow moving and keep patients safe and out of hospital. Sharing information, and indeed ensuring everyone has the same information is essential for this. 

Regarding treasury funding, Dawn noted: ‘’It is important to remember it is up to 6-weeks, therefore you should be aiming to [complete assessments and confirm placements] in less than 6-weeks. The 6-week timescale means there is more of a focus for speed.’’ 

Having visibility over what is happening in different cohorts and prioritising work is important. Additionally, tracking across different pathways is vital for managing expectations. 

Both Dawn and David concluded by stating that for community pathways to become better established, more communication and joint responsibility is needed to make sure patients are in the right place at the right time. If there is clear communication, and everybody knows what they are expected to do, we can provide a better overall discharge experience for patients.

CHS Healthcare has been supporting CCGs with hospital discharge pathways nationally since 2013 and are well-placed to support CCGs and local authorities to tackle their current and ongoing priorities. For more information, contact to discuss your needs.

You can access a recording of the webinar here: 

As originally seen on LinkedIn

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