• Support earliest possible discharge
• Avoid unnecessary admission to hospital
• Rehabilitation : optimal independence
Aims
• Referrals to Service > Total number =over 2000
> Accepted = over 1800
• Evidence that 410 people have avoided hospital admission
• Facilitated E.S.D of 614 patients> increased availability of 3072 hospital bed
days> rapid assessment: early reduction in care
package
Statistics to date
New Developments
Concept: Continually evolve: Identified Need
• E.S.D. for COPD patients
• Development of Generic Worker role to enhance rehabilitation & clinical skills
‘Food for Thought’
March 2006 Travel Scholarship
• Australia
• Portsmouth
Potential models for Dumfries & Galloway
Silver Chain Organisation
• Personal Enablement Plan
• Health Improvement Plan
Increased support to patients at home: Generic Workers working to AHP’s.
Step Up/Step Down
• Nurse led beds in Community Units
• Rapid assessment> need for close observation> admission when necessary> early discharge - S.T.A.R.S. and AHP’s
• Supported in Community by S.T.A.R.S.> reduced hospital admissions> increased delivery of tailored rehab programme> increased potential for optimum independence
• Presence of Discharge Team member in A&E
• All older people appropriately screened and assessed
• Discharge Team member - extensive local knowledge of community services
• Identification of need: discharge follow-up
• No additional resource
PRO-ACTIVE IN-REACH PROGRAMME:A&E
RONA LAINGRONA LAINGACTING SENIOR MANAGERACTING SENIOR MANAGER
SOCIAL WORKSOCIAL WORKOLDER PEOPLEOLDER PEOPLE
SERVICESERVICE
FIFE HEALTH & SOCIAL CARE PARTNERSHIPFIFE HEALTH & SOCIAL CARE PARTNERSHIPDELAYED DISCHARGE FIFE TARGET – DELAYED DISCHARGE FIFE TARGET –
2005/062005/06
REDUCE ALL DELAYS IN HOSPITAL TO 73REDUCE ALL DELAYS IN HOSPITAL TO 73
REDUCE ALL DELAYS OVER 6 WEEKS TO 40REDUCE ALL DELAYS OVER 6 WEEKS TO 40
REPORTED DELAYS ON 15/04/06 = 71REPORTED DELAYS ON 15/04/06 = 71
REPORTED DELAYS OVER 6 WEEKS ON 15/04/06 = 21REPORTED DELAYS OVER 6 WEEKS ON 15/04/06 = 21
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP
FIFE TARGET 2006/07FIFE TARGET 2006/07 REDUCE DELAYS OVER 6 WEEKS TO 20REDUCE DELAYS OVER 6 WEEKS TO 20
REDUCE DELAYS IN SHORT STAY BEDS TO REDUCE DELAYS IN SHORT STAY BEDS TO 11
REPORTED DELAYS ON 15/04/07 OVER 6 REPORTED DELAYS ON 15/04/07 OVER 6 WEEKS = 17WEEKS = 17
REPORTED DELAYS ON 15/04/07 IN REPORTED DELAYS ON 15/04/07 IN SHORT STAY BEDS = 0SHORT STAY BEDS = 0
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP
Delayed Discharges Reported to ISD May 2006 to April 2007
0
20
40
60
80
100
120
Census Dates
Nu
mb
er
of
Pati
en
ts
Total Numbers Reported to ISD
Total Numbers Reported to ISD Over 6 Weeks
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP
ACHIEVING THE TARGETACHIEVING THE TARGET
MONTHLY VERIFICATION OF DATAMONTHLY VERIFICATION OF DATA
WEEKLY MONITORING FOR 6 WEEKS PRIOR TO WEEKLY MONITORING FOR 6 WEEKS PRIOR TO CENSUS DATECENSUS DATE
PARTNERSHIP AGREEMENT ON CODINGPARTNERSHIP AGREEMENT ON CODING
ROBUST CARE MANAGEMENT AND ROBUST CARE MANAGEMENT AND MONITORING OF PROGRESS TO DISCHARGEMONITORING OF PROGRESS TO DISCHARGE
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP
PROCESS IMPROVEMENTPROCESS IMPROVEMENT GUIDANCE ON CHOICE POLICYGUIDANCE ON CHOICE POLICY
APPLICATION OF THE GUIDANCEAPPLICATION OF THE GUIDANCE
ROLES AND RESPONSIBILITIESROLES AND RESPONSIBILITIES
JOINT ACTION PLANJOINT ACTION PLAN
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIPRESOURCESRESOURCES
HOSPITAL BASED ASSESSMENT AND HOSPITAL BASED ASSESSMENT AND CARE MANAGEMENT TEAMSCARE MANAGEMENT TEAMS
DISCHARGE SUPPORT NURSESDISCHARGE SUPPORT NURSES
SHARED I.T. SYSTEMSSHARED I.T. SYSTEMS
BUSINESS & SYSTEMS SUPPORT STAFFBUSINESS & SYSTEMS SUPPORT STAFF
FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP
ESSENTIALS TO SUCCESSESSENTIALS TO SUCCESS
SHARED VISION/OBJECTIVESSHARED VISION/OBJECTIVES
DEDICATED STAFF TEAMSDEDICATED STAFF TEAMS
REGULAR COMMUNICATIONREGULAR COMMUNICATION
PROBLEM SOLVING APPROACHPROBLEM SOLVING APPROACH
SENSE OF HUMOUR!SENSE OF HUMOUR!
Delayed DischargeDelayed DischargeWarts and All….Warts and All….
Emerging Themes From The Emerging Themes From The 2004/5; 2005/6 & 2006/7 Census2004/5; 2005/6 & 2006/7 Census
Two Ways of Managing a Two Ways of Managing a Census….Census…. Quarterly or Quarterly or
annuallyannually Debate the Debate the
definitions definitions Robust Robust
management management (shouting and/or (shouting and/or weeping)weeping)
Throw money at Throw money at the listthe list
WeeklyWeekly Clear Clear
understanding of understanding of reasons for delay reasons for delay allows…allows…
Constant Constant management management and…and…
Consistent funding Consistent funding decisionsdecisions
The Census Day 2004/5The Census Day 2004/5Success is…..Success is…..
Target 43Target 43 Census minus one week 78Census minus one week 78 0900hrs 390900hrs 39 1200hrs 461200hrs 46 1700hrs 371700hrs 37
Accurate; Current.. “The List”Accurate; Current.. “The List”
The SW List informed the…The SW List informed the… The NHS List which was bigger The NHS List which was bigger
than above…than above… The Joint List ….had decayedThe Joint List ….had decayed The Lists not regular, but The Lists not regular, but
collected for censuscollected for census Managers didn’t hold and Managers didn’t hold and
monitor the lists.monitor the lists.
AnomoliesAnomolies
The “Long Term” DD who is not The “Long Term” DD who is not reviewedreviewed
The “compassionate” DDThe “compassionate” DD The DD with no discharge date The DD with no discharge date ““Predictable Incapax” at point of Predictable Incapax” at point of
discharge discharge Hidden DD’s and backdatingHidden DD’s and backdating Virtual DD’sVirtual DD’s
…….So For 2005/6.So For 2005/6
Agreed DefinitionsAgreed Definitions ““Amnesty” and senior sign off of local Amnesty” and senior sign off of local
agreement of listsagreement of lists Named local managers/collatorsNamed local managers/collators Changed focus for DD Action TeamChanged focus for DD Action Team Real time management information Real time management information
including value of codesincluding value of codes Management, not administrationManagement, not administration
2005/6…Success Is…..2005/6…Success Is…..
Increasing by 200+%.....Increasing by 200+%..... …….then receiving “support and .then receiving “support and
encouragement”encouragement”
NHS Highland Delayed Discharges Bed Days Lost Apr 2004 to 19 Oct 2006
(excluding 51x Patients)
0
500
1,000
1,500
2,000
2,500
3,000
2004/05 2005/06 2006/07
Delayed Discharge 2006/7Delayed Discharge 2006/7
Differential Impact on Differential Impact on HospitalsHospitals
(9)
(6)
(3)
0
3
6
9
12
15
Belfo
rd, F
ort W
illia
m
Cai
thne
ss G
ener
al, W
ick
Cou
nty
Hos
pita
l Inv
ergo
rdon
Dun
bar H
ospi
tal,
Thur
so
Ges
to H
ospi
tal,
Skye
Ian
Cha
rles
- Gra
ntow
n on
Spe
y
Law
son
Mem
oria
l - H
AHT
-G
olsp
ie
Mac
kinn
on M
emor
ial,
Broa
dfor
d, S
kye
Mig
dale
Hos
pita
l, Bo
nar B
ridge
New
Cra
igs
Hos
pita
l, In
vern
ess
Portr
ee H
ospi
tal S
kye
Rai
gmor
e, In
vern
ess
RN
I Com
mun
ity H
ospi
tal,
Inve
rnes
s
Ros
s M
emor
ial,
Din
gwal
l
St. V
ince
nt's,
Kin
guss
ie
Tow
n &
Cou
nty,
Nai
rn
Tow
n &
Cou
nty,
Wic
k
Bed
s Lo
st
Comparative Delayed Comparative Delayed Discharge At End Of 2005/6Discharge At End Of 2005/62004/05 Performance2004/05 Performance Target 39 Actual 37Target 39 Actual 37 264 patients; 27,629 bed days264 patients; 27,629 bed days
2005/06 Performance2005/06 Performance Target 34; Actual 10Target 34; Actual 10 Six Week Target 19; Actual 3Six Week Target 19; Actual 3 Acute Target 5; Actual 2Acute Target 5; Actual 2 Max Wait 56 daysMax Wait 56 days 384 patients……29,582 bed days384 patients……29,582 bed days …….the wrong targets? .the wrong targets?
Performance Issues 2006/7Performance Issues 2006/7
Knowledge, awareness & late Knowledge, awareness & late startersstarters
Systems and responsesSystems and responses NHS/SW relationships and NHS/SW relationships and
engagement & pushing responsibility engagement & pushing responsibility downdown
Targeting of patientsTargeting of patients Managing now, not future ideasManaging now, not future ideas Achieved……..Achieved……..
Delayed Discharge 2006/7Delayed Discharge 2006/7
Target 28 Actual 24Target 28 Actual 24 Short stay 9 Actual 7Short stay 9 Actual 7 Six Weeks 11 Actual 9Six Weeks 11 Actual 9
Success is……Success is……
136% increase on last year??? 136% increase on last year???
OROR Actual reduction of Occupied Actual reduction of Occupied
Bed Days 15k…47%..£3.1m !!!!!Bed Days 15k…47%..£3.1m !!!!!
A Journey Through Delayed A Journey Through Delayed Discharge PerformanceDischarge Performance…..A Reality Check…..A Reality Check DisengagementDisengagement Monitoring a deteriorating Monitoring a deteriorating
situationsituation Actively managingActively managing Performing & deliveringPerforming & delivering Eye goes off ball…Eye goes off ball… ……and is brought back by weekly and is brought back by weekly
reporting regime.reporting regime.
But….But….
The system is now moving too The system is now moving too fast….fast….
Implications for balance of careImplications for balance of care Anticipatory Care?Anticipatory Care?
A Final Thought..A Final Thought..
No pudding till you finish your No pudding till you finish your greens?greens?
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