Addressing some of the issues associated with delayed transfer of care by Felim McCarthy of Restart Consulting.
There is clear evidence that when a person spends time in hospital when they are medically fit, their future health and longevity is adversely affected. The National Audit of Intermediate Care argues that ‘for older people a delay of more than two days negates the additional benefits of intermediate care and seven days is associated with a 10% decline in muscle strength due to long periods of immobility in a hospital bed.’
Delayed transfers of care impact negatively on both the performance and finances of health and social care service provision. A patient fit for discharge may not require the same intensity of care, but the hospital must still provide staff and associated resources, linen, food, medications etc.. Whilst the NHS in recent years has decreased the overall number of beds, the number of admissions has continued to rise. This leads to ‘Winter Pressures’, queues in Emergency Departments, cancelled elective admissions, alongside the aforementioned detrimental effects on individual patients.
There is no single cause of delayed transfers of care. Thus, there is no single remedy. However, in the latest available figures (2016/17) there are two examples where improved communications across and between organisations would provide a means of reducing the delayed transfer of care. These are;
- Awaiting completion of assessments 380,832 delayed days
- Awaiting community equipment and adaptations 52,121 delayed days
Source NHS England
Although neither of these are the reason behind the highest number of delayed days, (Awaiting Care Package, in own home 456,447 delayed days), they are easier to address through improved communications.
Such communications should start at the time of admission or even before if the admission is elective. Engaging the multidisciplinary team in the assessments necessary for a safe transfer of care in a timely manner, not only ensures safe discharge of the individual, but also improves communication between teams and could result in better outcomes.
Where changes to the home or the provision of assistive equipment is required, the earlier the service providing these supports can be engaged, the more likely it is that these will be completed on time. In order to ensure that such collaboration can begin as soon as possible and be completed in a timely and effective and efficient manner, there is a requirement to ensure that all the relevant data is available to those making the decision.
Many elderly, and some not so elderly, patients are admitted to hospital for an expected short length of stay. Some examples may be the replacement of a hip-joint or the treatment of dehydration and the associated confusion.
When the consultant in charge makes the decision that the person is medically fit for discharge, it is assumed that the clock for delayed discharge would begin. However, this is not the case in the NHS in England. The clock for the start of delayed discharge reporting only begins when the multi-disciplinary team has agreed a package of care following discharge. This in itself may be an incentive to not complete the process, since once completed, the period of delay must be reported.
Ensuring the discharge of the individual is undertaken in an efficient, effective and timely manner requires collaboration of all those involved.
This collaboration should ideally begin at the time the decision to admit the individual is taken. In most cases the team involved in the immediate and follow up care have a range of source systems on which they rely for the management of their individual services. This is not conducive to the sharing of data and the availability of information required to make informed decisions in a timely manner. There remains within the NHS and Social Services a high reliance on the use of paper to plan and share data, and to achieve the objective required to facilitate a safe discharge from hospital to care in the community.
This is a problem which Viper 360 Presentation Layer has been designed to assist in solving. The Viper 360 Presentation Layer provides individual staff with a clear view of the additional data that they may require in order to undertake their roles effectively. It is not a replacement for the core / source systems. It does not rely on any particular Integration Engine and it is available on any current web browser.
Using the Viper 360 Presentation Layer solution, clinical and professional staff are able to see data from other systems and thus augment the data which is available from their own source system. The augmented display is provided in a similar manner to a range of social media solutions which enhances utilisation and reduces the requirement for additional training.
Viper 360 Presentation Layer pulls data from the source systems in real-time and this means that individuals involved in the delivery of care are using the most recent information on which to base decisions. The Presentation Layer also provides the functionality for ‘write-back’ and can be created so as to have a data store for messages and images if required.
Each individual group of users will be consulted to ensure that the Presentation Layer view which they have is that most suited to their requirements.
Since the data shared is that related to the direct care of the individual, there is no requirement for consent. Sharing of the data is covered under the Health and Social Care Act (2012) a. In turn this results in a more rapid implementation of the solutions as IG constraints are removed.
Moving beyond the professional use of Viper 360 Presentation Layer, the carer of the patient can also be provided with access to the system. The level of data provided, and the way in which it is presented, can be tailored to suit the requirements of non-professional users.
Access to the Viper 360 Presentation Layer is through the user of a web browser meaning there is a zero footprint on organisational PCs or Laptops.
Utilising the electronic forms which can be developed for Viper 360 Presentation Layer, organisations can create a range of interactive documents. It is also possible to link the existing Electronic Document Management solutions and the PACS systems to provide a richer historical view of the individual, where required.
By enabling the presentation of data and the associated sharing of interventions, the Viper 360 Presentation Layer enriches the collaboration between professional groups, reduces the delays associated with the current sharing of information, improves communications across and between organisations and ensures an efficient discharge of the patient and proper ongoing care.
In turn this will assist in reducing or even eliminating the harmful effect of delayed discharges on the patient as well as improving throughput in acute hospitals and assisting in better budget control.