The Ward Round: Why your trust needs an OT

The debate around workforce shortages in the NHS is often focused on doctors and nurses, the largest and most visible staff groups. However, as made clear by the long-term plan for the NHS, allied health professionals significantly support the demand faced by the NHS and there are studies that demonstrate they improve patient flow. Read HSJ article here - if you have problems access the journal please contact the library on 01905 760601

High impact change model: managing transfers of care

This change model, developed by the Local Government Association with the Association of Directors of Adult Social Services, outlines a practical approach to managing patient flow and hospital discharge. It identifies eight system changes that will have the greatest impact on reducing delayed discharge. The resource supplements the model by bringing together examples of work being undertaken across the country, for each of the eight system changes.

Planning for seasonal demand in respiratory illness

Each winter, emergency departments experience a surge in respiratory attendances and emergency admissions for respiratory conditions double. It is therefore crucial to plan for this inevitable increase in demand so that patient flow is maintained.

A “quick guide” from NHS Improvement highlights ways to manage demand, including ambulatory emergency care, early supported discharge services, and urgent “hot” clinics. Use of these initiatives can reduce avoidable overnight admissions and improve patient flow and outcomes.

Local A&E delivery boards are advised to consider the recommendations as part of plans to manage the seasonal surge in respiratory admissions.

Preparing for winter

The Preparing for winter guidance from the Royal College of Physicians covers the delivery of care, patient flow, wellbeing of the workforce and minimising unnecessary hospital occupancy.

Flow in providers of community health services: good practice guidance

Good patient flow across health and social care systems is crucial for the NHS to run an effective and sustainable service. If patient flow is poor hospitals become congested, clinical outcomes are poorer, financial performance deteriorates and staff will be overstretched.

Delayed discharges from non-acute providers have risen as much as in acute providers over the last two years, and we recognise how important it is that we focus on the interface between community services, and other health and social care services.

The SAFER patient flow bundle and Red2Green days approach

NHS Improvement has provided resources that will help you implement the SAFER patient flow bundle and Red2Green days in your organisation. When followed consistently, these can reduce length of stay and improve patient flow and safety.

See also:

• SAFER patient flow bundle: board rounds
• SAFER patient flow bundle: ward rounds

Emergency flow improvement tool

Trialled with 150 staff including 30 acute hospitals, NHS Improvement has developed this emergency flow improvement tool. It provides extensive information and allows:

• you to appreciate and understand where the bottlenecks and strains are within the system and implement plans to tackle them
• you to use this information to implement plans that can help see and treat patients more quickly
• leaders and board members to have an overview of their organisation's performance

Managing patient flow and improving efficiencies: The role of technology

Having witnessed tracking technology first hand in two American health care organisations, Sophie Castle-Clarke sets out its strengths and how to implement it successfully.

Technology to track beds, equipment, staff and patients through a hospital has been used in the USA for years, with positive effect, and now there is growing interest in employing it in the NHS.

I joined a group of NHS leaders to look at how this technology has made a difference to flow and operational management in two different health care organisations in Florida. The results are impressive, although significant transformation is needed to realise the benefits.

Patient Flow – managing expectations and improving throughput

Here is a real-time patient journey assessment and visualisation tool created by Central Manchester University Hospital NHS Foundation Trust.

Case studies: Improving Patiient Flow

This series of case studies explains how selected providers are delivering effectively against good practice priorities. These stories accompany our Good practice guide: Focus on improving patient flow and explain how providers have sought to localise and practically implement the principles of good patient flow.

The case studies are from the Trusts listed below, the link to the case studies is on the NHS Improvement website

• Ambulance handovers (Barts Health NHS Trust)
• Primary care streaming (Luton and Dunstable University NHS Foundation Trust)
• Emergency departments (Royal Berkshire NHS Foundation Trust)
• Mental health (Cambridgeshire and Peterborough NHS Foundation Trust)
• Clinical decision units (University Hospitals Bristol NHS Foundation Trust)
• Ambulatory emergency care (Mid Cheshire NHS Foundation Trust)
• Acute medical units (Salford Royal NHS Foundation Trust)
• Frailty (Poole Hospital NHS Foundation Trust)
• Specialties (Western Sussex Hospitals NHS Foundation Trust)
• Discharge (South Warwickshire NHS Foundation Trust)

Good practice guide: Focus on improving patient flow

Good patient flow is central to patient experience, clinical safety and reducing the pressure on staff. It is also essential to the delivery of national emergency care access standards. Experts consistently advocate focussing on patient flow as a key factor in providing effective health care.

The good practice guide from NHS Improvement is also accompanied by a series of case studies that offer examples of how providers have implemented some of the principles in the guide.

Cumbria’s NHS joining forces to get patients up, dressed and moving

NHS Trusts in Cumbria have joined forces to raise awareness and help patients across acute and community hospitals to get up, get dressed and get moving.

The campaign, which is in already popular on social media, is aimed at enabling hospitalised patients to get up, dressed and moving in order to avoid the potential negative impact of being bed-bound while in hospital.

Barbara Pinguey, specialist physiotherapist at North Cumbria University Hospitals NHS Trust, said: “By getting up, dressed and moving, patients can speed up their recovery, get home sooner and maintain their normal routines."

HSJ Value in Healthcare Awards 2017: Emergency, Urgent & Trauma Care

In November 2014 Sherwood Forest Hospitals was the second to the bottom in the ED four-hour target performance in England. The ED department had been rated as ‘inadequate’ for safety in 2015 and the trust had 17 patients breach 12 hours during December 2014 and January 2015.

The trust recognised that this was not just a problem for ED to solve and so created the Emergency Flow Programme, which is organisation wide.

Older People in Acute Care Improvement Programme

With the number of older people increasing in our population, the need to ensure that they receive appropriate care in our healthcare system also increases. The ‘Improving Care for Older People in Acute Care’ workstream is a two-year programme to improve the care for older people in acute care. This work complements the scrutiny programme currently taking place to identify strengths and areas for improvements across hospitals in NHS Scotland.

Getting patients home for lunch

Getting patients home for lunch Sent in partnership with Cumbria County Council.

A drive to get people who are ready to leave hospital home in time for lunch is proving beneficial for patients and the local health system.

Cumbria Partnership NHS Foundation Trust (CPFT) has recently renewed a drive to get patients home from hospital in time for lunch and it’s showing great results.

53% of patients who left CPFT inpatient wards in February did so before lunch, compared to a national target of 33%.

The number of patients leaving before lunch has been steadily increasing and remained above the national target since July 2016.

Ward staff are working with teams in the community, partner organisations, patients and their families to get patients home as soon as it is safe to do so with the right support in place.

Read more HERE

Nursing directors: we want to help you increase nurse/criteria led discharge

By October 2017 every NHS provider and their local health and social care partners must have adopted good practice to enable appropriate patient flow. This includes better and more timely hand-offs between A&E clinicians and acute physicians, 'discharge to assess', 'trusted assessor' arrangements, streamlined continuing healthcare processes, and seven day discharge capabilities.

NHS Improvement's analysis suggests that up to 25% of non-elective patients in hospital beds could be discharged immediately and a further 25% are in hospital because of delays that are within the gift of NHS providers.  It wants to help you tackle these delays in discharge, and would like to hear how NHS Improvement can support you to increase nurse/criteria led discharge and the challenges you’re facing in doing this.

Remote health management: reducing bed blocking in the NHS

Institution of Mechanical Engineers (IMechE) - 
This report highlights the potential for remote monitoring technology to ease delayed discharges in the NHS and estimates that the widespread implementation of digital health could have already saved the NHS over £1 billion over the last five years. The report calls for the Department of Health to create a standardised remote health management network by 2020 which would enable acute and social care providers to have access to patient data and remote monitoring.

• Report

Red2Green approach

Mark Cubbon discusses how the Red2Green approach is helping reduce unnecessary delays for patients across the Midlands and East of England and why it's gaining momentum on social media.

New report shows the way ahead to tackle delays and duplication across health and social care

The Health Foundation and the Advancing Quality Alliance (AQuA) have published The challenge and potential of whole system flow, a guide to help local NHS and social care leaders to work together to improve productivity, patient experience and the quality of services.

The report says poor flow not only wastes time, energy and money, it can hurt patients and is deeply frustrating for people working in health and social care. The report cites common examples of poor flow: ambulances queuing outside hospitals; stretched emergency departments; problems getting a GP appointment; and mental health patients being transferred hundreds of miles for a bed.

The report argues that the current context for health and care providers – including significant financial pressures and the emergence of new local partnerships (the Sustainability and Transformation Plan partnerships in England) –present an opportunity for a serious focus on tackling flow across NHS and social care systems.

Health Foundation response to the Health Select Committee’s report Winter pressure in accident and emergency departments

Responding to the publication of the Health Select Committee’s report on winter pressure in accident and emergency departments, Dr Jennifer Dixon, Chief Executive of the Health Foundation said: ...