28 / 01 / 2016
Five years ago Sheffield Teaching Hospitals, like many hospitals, had a problem. Older people, admitted as an emergency, were spending a considerable length of time waiting to be discharged once they were medically fit to leave hospital.
After spending time listening to people and examining the traditional ways of working, the Sheffield team, which comprised a multidisciplinary group of clinicians and non-clinicians, realised they could make a significant change to the length of stay for older people while also improving their experience and care.
The teams caring for older people were challenged by the traditional method of assessing medically fit patients for discharge home, which could often lead to longer lengths of stay in hospital than necessary and also a predicted higher level of home support than was actually required.
The Sheffield team, with involvement from service users, decided to turn things on their head and instead of determining fitness to return home by assessing patients in the artificial surrounds of the hospital environment, they trialled assessing patients in the more familiar surroundings of their own home. The aim is to assess the patient at home within a day of the decision that they are medically fit to discharge.
As the starting point for change, a single medically fit patient was taken home and assessed in their own home by a physiotherapist. The patient’s bed was kept available in case their care needs could not be met at home in real time. The patient in fact proved to be very confident in their own home and the visit ended up with the patient making the physiotherapist a cup of tea.
This patient and many more showed that assessment in familiar surroundings proved a useful way of judging how they would cope on discharge. In general, it showed people needed a lower level of support at home than staff would have expected from seeing them in hospital. The process was iteratively refined and expanded, and discharge to assess (D2A) has now been rolled out further in the trust. Readmission rates have not been affected and the number of patient falls has reduced in the group of patients who were assessed at home, because patients are less likely to fall in their own home. Shorter stays mean they are also less likely to get hospital-acquired infection.
Patient satisfaction has been high and, in the past year in Sheffield, more than 7,000 older patients have been discharged home in an average of 1.1 days compared with 5.5 days three years ago – a saving of over 30,000 bed days and a higher quality of patient experience.
For more information:
Tom Downes, Consultant and Clinical Lead for Quality Improvement