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MEDWAY

MEDWAY. Setting the scene. Acute trust in special measures Focus on three areas of improvement Discharge to Assess pilot - September 2015 Other models explored 8 WEEKS. Quotes that made an impact Home First Principle (Ian Sturgess)

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MEDWAY

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  1. MEDWAY

  2. Setting the scene.. • Acute trust in special measures • Focus on three areas of improvement • Discharge to Assess pilot - September 2015 • Other models explored 8 WEEKS

  3. Quotes that made an impact Home First Principle (Ian Sturgess) No patient should ever enter hospital and never return to see their home ever again (Liz Sergeant) Understand and successfully operate the existing business – Alignment (Ian Sturgess) Need to remove barriers and perverse incentives created by contracts and organisational boundaries via planning and working collaboratively (Ian Sturgess)

  4. OUR AIM

  5. Our aim was to speed up hospital discharge times and improve patient outcomes We pledged that we would support patients who might need assistance at home by providing assessment of needs in the patients own home; setting goals and providing any necessary support; promoting independence and reducing the need for ongoing long term care in the future

  6. A multi-agency partnership initiative working across the whole health and social care system to reduce unnecessarily prolonged lengths of stay in an acute hospital. Facilitating more timely and effective hospital discharges, achieved by the community providing holistic assessment, equipment and on-going enablement and support in the patient’s own home or intermediate care facility instead of in the hospital. Facilitating up to 35 discharges onto Pathway One per week, including weekends.

  7. Designated Lead • Pathways

  8. Pathways – The Medway model designed four pathways to get people out of the hospital quicker:

  9. Designate a lead – supported by a core group • Pathways– keep it simple • Single Point of Access (SPA) – one call does it all • Staffing– flex resource across the whole system • Enablement agency support – free care for all • Board rounds –trusting decisions • Equipment provision – quick access • Transport - reliable • Wrap around support – substitute for care visits • Comms– spread the message and the vision • Contingency and escalation plans – it may not be perfect but it can be good enough • Branding

  10. Themes & Issues • No EDN’s • Wards not calling to inform us the patient had left the ward • Patients not ready to leave by 3pm • Backlogs & ‘roll overs’ • Numbers and trends • Bypassing of the systems in place • Some complex needs required more planning before discharge • Creation of new/alternative pathways

  11. What has been achieved so far.. • Time… • Discharges under Home First… • Reduction in stranded patient numbers… • Reduction in DTOC • Change in culture… • Reduction in long term care reliance… • Improved patient flow… • Recognition… • Great working relationships…

  12. Challenges (acute) Delayed/aborted discharges due to: • EDN’s • TTO’s • Waits for a decision by a senior doctor • Increased temporary nursing staff on the wards, unfamiliar with patients and processes. • Poor uptake at the weekends (zero referrals on Sundays)

  13. Criteria led discharge (CLD) • Patients identified on board rounds who would be candidates for home first when medically optimised • EDD’s • Clear criteria and parameters to be met for discharge entered onto the electronic bed management system (BMS) • Patients/families included in the discharge planning • Proactive completion of EDN • Bleep holder support for junior staff out of hours • Clear escalation processes

  14. What’s new? • Day before referrals • Transport booked the day before discharge • Increased numbers discharged via this pathway • Proactive not reactive • Increased numbers of patients discharged before 10am • Improved weekend discharges • Improved performance

  15. MEDWAY

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