Our recent analysis of NHS data found that the number of patients stranded in hospitals across England on Christmas day despite being medically optimised could rise to 14,178, a 54% increase on the 9,200 patients who remained in hospital last Christmas. As we head towards the middle of an intensely pressured winter, we’ve created a 12-step checklist to ensure all bases are covered when managing pressures this winter and beyond.
1. Collaborate across teams
The current hospital discharge model is based on multiple different teams all performing specific tasks. We must improve how these teams work and plan together, ensuring increased continuity of care through case management, breaking down silos between disjointed teams and ensuring families and carers are informed every step of the way. Poor communication between teams has been shown to increase discharge delays so this approach can help reduce discharge delays for medically optimised patients.
2. Extra resources
Many UK hospitals are operating at full capacity and hardworking staff are working flat out to deliver the care that their patients need. With the existing discharge operating model so complicated and burdensome, staff barely have a spare minute to spend on the admin processes required for discharging patients. The resource cannot be found inside an already stretched workforce. The NHS should consider collaboration with the private sector who can provide extra resource and capacity, meaning that hospital staff will have more time to be there at the bedside with patients.
3. Reduce admin
54% of care home staff and managers and 49% of hospital staff responding to our recent survey reported that one of the top factors contributing to delays in discharge is paperwork, admin and bureaucracy. With staff resource and capacity in extremely short supply and paperwork can easily fall by the wayside and add additional pressures. Processes can be made more efficient to reduce the admin burden on staff, freeing up more time to focus on getting well patients out of hospital.
4. Engage with families
Families and next of kin should be involved at every step through admission to discharge. In our survey, 92% of hospital staff agreed that engaging with the patient’s family and carers early on makes for a successful discharge. However, this does not always occur, meaning that the discharge process is delayed by conversations with families that should have started at an earlier stage.
5. Digital oversight
Many hospitals still rely on paper-based patient records. Records can be easily lost and it takes additional time and effort to find and send the relevant papers, further slowing down the discharge process. This ultimately results in staff loosing valuable time to otherwise avoidable or repetitive tasks. Technology and data can unlock flow, allowing safe automation and accurate prediction of when patients will be medically optimised.
6. Embracing new technology
The advent of new virtual ward and remote monitoring technologies enables patients who would otherwise occupy a hospital bed to be monitored and supervised safely at home. For many patients, this approach is far preferable. They can receive the same care and treatment in a familiar environment close to family and loved ones and avoid the anxiety of not knowing when they will be discharged. Numerous case studies and pilots are revealing the success of virtual wards and remote monitoring, and effective usage of this technology can help to tackle the bed occupancy crisis.
7. Digital prediction tools
What if hospitals could predict the exact day that a patient may be ready for discharge? This approach would dramatically enhance patient flow by allowing discharge plans to be put in motion ahead of the day the patient becomes medically optimised. For example, families could get their relatives home environment ready, or care homes could have a place reserved, rather than a frantic rush on the day to get the patient out as soon as possible. By collaborating with innovative private providers, hospital and care home staff can utilise such technology to transform patient flow.
8. Case management
In the current hospital discharge operating model, patients are passed along the chain with insufficient focus on case management from point of admission to discharge. This type of system can be detrimental to patient care, as crucial information can be lost in the chain, impacting hardworking professionals who are required to double check and second guess to ensure patients’ needs are being met. Effective case management from admission to the hospital back door is critical to improving patient flow. When patients receive joined up care throughout the entire discharge pathway, planning can be done in the most efficient way possible.
9. Planning from the start
NHS guidance states that discharge planning should start at admission – but our survey showed that in 31% of cases, hospital discharge is not discussed until treatment nears completion or once the patient is medically optimised. With all the barriers to effective discharge in place, it’s easy to see how patients can spend weeks longer in hospital than they need to due to ineffective planning. Due to the complexity of the discharge process things don’t always go to plan. There might be difficulties contacting the patient’s next of kin, care homes in the area might be full, the hospital could have lost important paperwork. These factors can add further delays so it is important to have capacity in the workforce to deal with issues when they arise.
10. More use of Discharge to Assess
Our survey also revealed that 2 in 5 hospital workers (40%) are unaware of the government’s ‘Discharge to Assess, Home First’ policy. This guidance is designed to avoid delays in care discharge by providing short-term care and reablement in people’s homes or by using ‘step-down’ beds to bridge the gap between hospital and home. We welcome further consideration of D2A as a longer-term solution to tackling current NHS pressures, but to succeed, the scheme requires a collaborative approach across the NHS, social care, private providers and the voluntary sector.
11. Understanding the local community
Understanding needs of the community is important for early care planning. Currently hospitals have a reactive model in place – reacting to patient’s needs when they present in A&E or emergency departments. But what if we could look further ahead of this and anticipate potential care needs in the community before they lead to hospitalisation? Developing our understanding of population health in our local communities can help to anticipate acute concerns, and understanding people’s broader social and living situations can help put plans in motion for discharge before they are admitted in the first place.
12. Planning for the future
The pressures faced by the NHS in recent years have been like nothing on record. There are valuable lessons to be learnt from how crises have been managed that we can apply going forward. With efficient discharge and patient flow processes in place, hospitals won’t bear the brunt of external pressures as much as they would if they were already at full capacity. Decision makers can look to examples of innovation and effective partnerships between the NHS, social care, voluntary sector and private sector where discharge processes have been successfully transformed, and continue to apply these going forward.
By redesigning the hospital discharge system, NHS services can reduce pressure on staff and improve access to and quality of patient care.
Contact us to find out more about how CHS Healthcare can help you this winter: enquiries@chshealthcare.co.uk
As originally seen on LinkedIn