Contents
Aims
Flow throughout the system is crucial to help services provide timely and effective person-centred care. There must be enough capacity to manage demand.
Context
The flow of people in and out of services needs to improve if integrated care systems (ICSs) are to provide effective, joined-up care for people.
Currently, the healthcare system features several barriers that create difficulties throughout an ICS. Barriers to accessing social care can result in delayed discharge for people. This, in turn, makes it difficult for other patients to access inpatient care, which affects provision of urgent, elective and cancer care. Finally, this affects access to timely primary and pre-hospital care.
ICSs must use their autonomy to seek and provide solutions that dismantle these barriers.
Useful resources
DHSC guidance on hospital discharge and community support
Royal College of Emergency Medicine’s Winter Flow Report
BMJ Journal: Six ways not to improve patient flow: a qualitative study by Sara Adi Kreindler
Key suggestions
- Adopt the recommendations from Patient FIRST.
- Ensure home transport systems are timely and effective and cover all the organisation's catchment areas.
- Use hospital at home and 'virtual wards' to provide practical support for early facilitated discharge.
- Show evidence of effective initial assessment by senior decision-makers in services.
- Provide the correct number of senior decision-makers in 111, 999, primary care and acute services. Determine the number needed based on patient acuity and demand. Staffing levels should be regularly reviewed to ensure the right level of risk is taken.
Examples of good practice and innovation
Working together to improve flow
Walsall Healthcare NHS Trust
The trust introduced several measures to maintain flow and reduce ambulance handover delays. They created:
- the Walsall Together partnership of health, social, voluntary, housing and community organisations
- a highly functional discharge lounge
- multi-specialty Same Day Emergency Care (SDEC) units
- culture and leadership that engages services from all specialties.
Long length of stay Wednesdays
Barnsley Hospital NHS Foundation Trust
This trust holds 'long length of stay Wednesday' meetings each week to discuss:
- people who have been hospital inpatients for longer than 7 days
- identify barriers to safe discharge.
As part of this, they use:
- a SAFER flow bundle from NHS Improvement (this is a practical tool to reduce delays for patients in adult inpatient wards)
- a length of stay dashboard with executive oversight.
Discharge to assess (D2A) service
South Warwickshire NHS Foundation Trust
South Warwickshire's D2A pathway is for people who are medically fit to go home, but are waiting for results, routine tests, physiotherapy or home care packages. They commission local care homes and individual practices to provide additional temporary care to help people access the care they need to step down to returning home.
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