Virgin Care worked across organisational boundaries with colleagues across the health economy in Surrey to introduce a discharge to assess pathway to help improve the way patients are discharged from the Royal Surrey County Hospital and cared for sooner within the community.
The project was implemented at no further cost to the NHS or commissioners and the pathway has helped more than 200 people discharge from hospital within 48 hours of assessment.
Virgin Care’s Rapid Response Service in Surrey is a multi-disciplinary service made up of physiotherapists, nurses, occupational therapists, social care practitioners and rehabilitation assistants who support patients after their discharge from hospital to keep them happy, healthy and at home – avoiding unnecessary visits to A&E, and admission to hospital.
Nationally, hospitals across England face ‘bed blocking’ – where patients who are medically fit to be discharged remain in hospital because there is a delay in community health and social care support being able to provide them with support– and the impact on hospitals is significant.
We worked with partners in the health economy in Surrey to pilot a new system – called Discharge to Assess – which helped ensure patients could be discharged sooner, by providing support in the community instead.
We implemented the project at no extra cost to the NHS, working in partnership with local acute hospitals, and the programme has continued to operate following the pilot.
All hospitals face growing demand for services and are looking for ways to reduce length of stay. Ensuring that patients don’t stay in hospital for any longer than is clinically necessary frees up capacity in the system, but also improves outcomes for patients.
The demand on hospitals is being influenced by a growing, ageing population with an increase in the proportion of chronic health problems.
Across the UK there are wide variations in length of stay, even for patients with similar conditions. This suggests that improvements can be made to the way that care is organised and delivered, particularly by ensuring that patients are discharged as soon as they no longer need acute care.
Delays in discharge, often known as ‘bed blocking’, can have an impact on a hospitals’ ability to reduce waiting times and deliver healthcare effectively.
The problem not only increases costs as occupancy rates rise, but also increases the risk of complications with a patients’ health.
Before our pilot took place, patients in Guildford and Waverley – an area of Surrey where we run community services – were only being discharged from the Royal Surrey County Hospital once all appropriate assessments and support resources were place, which had caused delays in discharging patients while community support was put in place.
The hospital wanted to reduce the effect, because it was meaning patients were spending longer in hospital than was medically necessary, and evidence has shown the negative effect on outcomes longer stays can have.
As a means of improving outcomes for the people of Surrey, we worked with our partners across the health economy to pilot a system that would help keep people out of hospital, out of care homes and in their own homes, living as independently as possible, for as a long as possible.
Discharge to Assess helps speed up the process of discharge, introducing more rapid support in the community improving outcomes for the patient, and freeing up acute hospital capacity.
More than 10 project members – including Virgin Care and colleagues from Royal Surrey County Hospital as well as social care and service user and carers – developed and planned how to jointly deliver the project to improve outcomes, and service user and carer experience, without incurring an additional cost to the NHS.
Firstly the acute hospital identify that a patient no longer needs or is benefiting from the hospital environment. Patients identified as being ready for discharge under the scheme are then referred to the Discharge to Assess team, and seen within 24 hours.
The team identify whether a patient’s ongoing needs can be met at home by the community health teams – and if they can, the patient will be discharged and support fully in place within 72 hours.
The team make sure the right level of care and support is in place straight away after discharge, working with the patient and their carers to keep them happy, healthy and at home.
The service also improves the range of services offered; as part of the new programme, all patients now have a fully therapy assessment, improving the service and allowing therapy to start sooner if it’s required.
The project group first met in July 2015 and the pilot started in February 2016.
The project team identified that a Single Point of Referral was required to enable the service to work, removing the separation between health and social care colleagues; the service also allowed improved communication between the partner organisations – helping make sure all colleagues were informed, engaged and equipped to deliver the very best service.
The pilot ran from February to August 2016; it immediately became ‘business as usual’ following the pilot, and is still in operation today due to the significant improvements that were seen by all partners.
Patients have benefited from being able to go home sooner and still receive the same rehabilitation treatment to help them remain at home for as long as possible, living as independently as possible, for as long as possible.
While the implementation of the joint triage process has also meant a more integrated service, with cross-organisational collaboration and less confusion about which service offers what treatments. The work has helped provide a better patient journey ensuring there are no gaps, duplication and waits are minimal.
The service is also in line with the vision of the future of health services in the NHS Five Year Forward View.
We delivered the project at no additional cost to the NHS or our commissioners by using existing resources.
With around 230 referrals into the Discharge to Assess team during the pilot, 193 patients benefited from an accelerated discharge process
More than half of patients during the pilot were discharged within the 72 hour target from referral overall, but the speed of discharge increased throughout the pilot. By August 2016, 82% of patients referred were being discharged with full support in place within 48 hours
More than a third of patients benefited from an ‘early alert’, where acute hospital clinicians and the discharge to assess team worked together towards a ‘predicted’ discharge date, allowing support to be put in place sooner
The positive results means a difference for patients, who are benefiting from discharge without delay, no need to distinguish between health or social care services, and a comprehensive rehabilitation, assessment and support service in place, at home.
Feedback from both service users and colleagues has said that the pathway has brought an improved difference to the service and to the hospital.
Feedback from a carer, a son providing care to his 96 year old father, told us the service listened to and understood the needs of his father during the process. The carer also reported he felt the team had listened to him and answered his questions.
One colleague involved in the programme told us: “Having a central service and person to refer to is much quicker and easier for colleagues, as well as patients and carers.”
The project has also highlighted potential for future improvements too: the community services are capable of increasing their capacity, speeding up discharges and potentially saving the NHS more money.
A lack of capacity in the community services during the pilot delayed 37 patients’ discharges, resulting in approximately 227 additional days’ stay in hospital.
Increasing capacity in the community services costs less than acute hospital beds, potentially saving the NHS around £50,000 during this short pilot alone.