Our seminars on hospital discharge planning are coming up on March 14th and 22nd. The Good Practice Exchange has worked together on this one with the Health team at the Wales Audit Office. Sara sat down with Anne to talk about why this seminar is happening now.
If you only had 1,000 days left to live,
how many of them would you choose to spend in hospital? (#last1000days)
Discharge planning is an ongoing process for identifying the services and support a person may need when leaving hospital (or moving between hospitals). The Wales Audit Office has recently completed reviews of the discharge planning arrangements across all the health boards. The reviews showed that whilst health boards have the frameworks in place to support discharge planning, there were a number of reasons that were preventing discharge from being as effective as it could be.
The majority of hospital discharges are relatively straightforward, but for approximately 20% of patients, discharge is much more complex for a variety of different reasons. The number of delayed transfers of care has been steadily increasing during 2017 and the number of patients delayed 13 weeks or more is rising. These delays in discharge lead to poorer outcomes for people through the loss of independence and mobility.
For every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and reconditioning takes twice as long as this de-conditioning. One week of bedrest equates to 10% loss in strength, and for an older person who is at threshold strength for climbing the stairs at home, getting out of bed or even standing up from the toilet, a 10% loss of strength may make the difference between dependence and independence. [Professor Brian Dolan, more info can be found at this website.]
One of the common themes coming out of the reviews was that there was opportunity to have greater integrated working throughout the discharge process, including stronger links to services in the community, to make sure the patients are receiving the right care, in the right place, at the right time.
We felt that this theme, in line with the Well-being for Future Generations (Wales) Act 2015 and the Social Services and Well-being (Wales) Act 2014, was tackling a key part of discharge planning – putting the patient at the centre. Patients are not concerned with who is providing which service, they just want to be assisted to achieve the best possible individual outcomes.
In essence, patient time as the key metric of performance and quality is best measured from the perspective of the person and is a journey not an event. [#last1000 days]
So at this seminar, you will find projects that are working across the sectors, navigating links to services in the community, showcasing truly integrated partnerships and joint working throughout the discharge planning processes and, most importantly, keeping the individual at the centre of the service. They are finding solutions to the variety of reasons which cause the delays in complex discharges, whether they are related to transfers of care, safety, homelessness, mental health, housing, assessments, or all of the above.
These projects are looking to provide you with food for thought, ideas you may be able to adapt to your own environment, or to spark new ideas. See what you can take back to your organisation or working environment which will help your patients to have better outcomes.
We would like to note that our background research also highlighted all the work that is going on to prevent admissions in the first place. In fact, there were so many that we decided that this area deserved a seminar all to itself, so that one will be coming up in February 2019.