Hospital Discharge Pathways

1 Hospital Discharge Pathways Philip Rankin BSUH Doctor and Clinical Lead BSUH Discharge Hub Learning Objectives best practice Hospital Discharge requirements during the Covid19 pandemic to effective Discharge planning and common concerns of staff pathway is your patient on? Hospital Discharge Pathways 0, 1, 2 and 3 and responsibilities enabling Discharge the new referral forms and processes, screening tools, Discharge planner and ward documentation hubs and integrated Discharge teams improvement relating to Discharge and championing best practice and community sector Discharge support concerns patients and carers have relating to Discharge and the tools available to support communication of Discharge to patients and ongoing care providers materials and professional development Discharge Planning The critical, quality link between Hospital and the community providing continuity of care.

2 Based on individual needs of the patient Multidisciplinary, integrated and whole system An ongoing process, not an isolated event Involves patients and carers as partners Discharge is as important as admission and starts from day one Discharge planning can even begin before arrival advance care planning More information on ReSPECT here Discharge Planning Independence - More people maintaining independence and returning to usual place of residence Staff - Improved staff satisfaction where staff can make decisions on the right information.

3 Work collaboratively in an efficient system with a wide range of colleagues, feel that their expertise is used, can develop new skills and roles. Patient - Improved patient experience feeling empowered, experience seamless service, understand what is happening and agree to it Carers - Carers feel valued, they understand what is happening, they have a role in decision making and feel confident. Strengths -Takes a strengths based approach what s strong rather than what s wrong Joyful reunion as dog welcomes owner, 96, back from Hospital Supporting Flow Doing the Right Thing - Valuing Patient Time #EndPJParalysis #Last1000 Days Key Questions for Us to Know and Communicate Discharge to Assess Purpose and Principles Home as default Home is more than own home Assessment in place best for person Continuity of coordination and clear.

4 Simple onward processes System approach Build awareness of acute and community re each others roles It works - DToC reduced by 25% in 3 months in Medway, Sheffield had 37% increase in patients discharged on day of admission or next day NHS England, quick guide to Discharging to Assess NHS England, quick guide to better use of care at home Liz Sargeant, Emergency Care Improvement Programme, Developing a Home First Mindset Health Education England, Care Navigation: a competency framework Housing LIN, Hospital to home resource pack Report link here BSUH Key Themes for Improvement The following themes were identified across BSUH during the Reset Week.

5 Need simplified Discharge Pathways which everyone agrees and understands EDD s, board rounds and Medway use Needs consistent approach & standard working Pharmacy Inconsistent availability & cover across all divisions & at weekends Discharge planning at point of admission Roles & responsibilities Wards & Integrated Discharge Team (Every ward to know Discharge support available to them, and the role the ward play themselves) Risk of over-assessment or inpatient input when community alternative available Internal central point of coordination required Click here for link to read more From 19 March, all systems must use a modified Discharge to assess (D2A) model to Discharge all patients who have been confirmed by a consultant as no longer meeting the criteria for acute care.

6 Once a decision has been made that someone should be discharged, they should be transferred to a Discharge lounge or suitable designated area within one hour and discharged from Hospital within a further two hours. Discharge home today should be the default pathway Written communication and setting expectations for all patients Click for RSCH files here and here, and PRH here Best practice board rounds X 2 / day Improving patient & staff experience of Discharge planning Making the most of the new patient Discharge handbook.

7 For patients (and staff): Please give handbook to patients as soon as possible in to their admission (latest within 24 hours) and discuss with them how to use it and keep safe and accessible. For all staff: The purple Discharge planner should be the central , regularly updated, accurate MDT record of Discharge planning and sits alongside the more patient-focused Discharge handbook For patients (and staff) Please support patients & carers (with MDT support) write key updates about their Discharge and enable them to be part of shared decision making and have a reliable record for their own purposes Checklists on page X and page X (going home day)

8 Please encourage and support patients and colleagues to consider items on the checklist S Senior Review A All to have EDD F Flow of patients E Early Discharge 45% before midday R Review MDT Key principles to think about with colleagues, carers and patients Planning Discharge from day 1 Going home day 1 2 3 For patients (and staff) Please support patients & carers (with MDT support) write key updates about their Discharge and enable them to be part of shared decision making and have a reliable record for their own purposes 2 For patients (and staff): Please give handbook to patients as soon as possible in to their admission (latest within 24 hours) and discuss with them how to use it and keep safe and accessible.

9 For all staff: The purple Discharge planner should be the central , regularly updated, accurate MDT record of Discharge planning and sits alongside the more patient-focused Discharge handbook 1 Improving patient & staff experience of Discharge planning Making the most of the new patient Discharge handbook. Full version here Discharge Checklists Checklists on page 4 and page 6 (going home day) please encourage and support patients and colleagues to consider items on the checklist Planning Discharge from day 1 Going home day 3 Look out for new BSUH Discharge planner coming soon!

10 Which Hospital Discharge pathway is your patient on? Ward led Print a copy for your clinical area here Pathway 1 Support to recover at home Patient returns to usual place of residence with interim support Discharge to Assess pathway (Responsive Services / JCR) New care package required or existing care package increase Temporary reablement to maximise independence Nursing / therapy assessment / intervention, eg new equipment or new community wound care Further Discharge pathway information Pathways are determined by Discharge destination and level of patient need Largest majority of discharges Restart of existing package of care with no change May include routine community nursing Discharge home with family or unpaid carer May require access to settle @ home services including Meals on Wheels Pathway 0 Simple Discharge Discharge home / usual place of residence Discharge back to care home Restart packages