TO ASSESS DISCHARGE - knowledge.scot.nhs.uk€¦ · Discharge to Assess Pathway Frailty Assessment...
Transcript of TO ASSESS DISCHARGE - knowledge.scot.nhs.uk€¦ · Discharge to Assess Pathway Frailty Assessment...
DISCHARGE
TO
ASSESS
Allison Nellies
OT Manager, Victoria Hospital, Kirkcaldy
March 2016
Discharge to Assess – What’s it All About?
Discharge to
assess is based
on the principle
that most frail
older peoples’
ongoing health
and care needs
are best assessed
in their home
environment.
The model of discharge to assess for frail older
people was referenced as “Best Practice” in the NHS
England Guide for commissioners (March 2014) and
by Philp (HSJ 2012). The model has been most
widely implemented in Sheffield Teaching Hospitals
Foundation Trust with a further publication “Good
Practice Case Study: improved flow through faster
discharge” in the HSJ November 2014. There are
many other examples of D2A across England.
The Fife model, a test
of change following
redesign of the front
door therapy service
differs from other
models in that it
supports “Meeting the
needs of Frailty:
Screening and
Assessment at the
Front Door of NHS
Fife” rather than the
back door which is the
focus of many other
programmes. It is
very much a
partnership project
between the Acute
Services Division and
the ICASS teams.
Discharge to Assess Pathway Frailty Assessment
AU1/A&E
Need for Further assessment
within home environment
identified and if provided would
facilitate safe discharge
Telephone call to Discharge to
Assess OT
Scan assessment to SPOA
OT assessment – self care,
kitchen tasks, transfers and
equipment, mobility, falls and
environmental assessments
Referral on to HCSW, PT, Home
Care etc OT continues to completion
What Are the Benefits?
Assessment is “context specific” with the patient’s
needs being more appropriately evaluated within
their home environment.
Being context specific leads to a safer discharge
for patients, preventing unnecessary readmission.
The model facilitates a more rapid assessment of
frail elderly patients at the front door, improving
flow through AU1 and the emergency department.
Timelines
Autumn 2015
OT started 06/10/15
Moved to KLM ICASS 02/11/15
OT started West Fife 06/01/16
OT started GNEF February
2016
Paper submitted to unscheduled care board with non recurring costs
approved until the end of March 2016
1 WTE band 7 OT from redesign
1 WTE band 6 OT – shared between 2 ICASS teams
2.68 band 3 – across all 3 teams
Geographical Area Existing Staff Additional Requirements
GNEF 0.5 WTE band 6, 1 x 0.67 WTE (25 hours) band 3
HCSW’s
KLM 1 WTE band 7 (from
acute redesign)
2 x 0.67 WTE (25 hours) band 3 HCSW’s
DWF 0.5 WTE band 6, 1 x 0.67 WTE (25 hours) band 3
HCSW’s
Total Requirements 1.0 WTE band 6, 2.68 WTE HCSW band 3
Emerging Outcomes
Activity
0
50
100
150
200
250
300
Direct contact Indirect contacts Travel time
Nu
mb
er
of
15 m
inu
te u
nit
s
OT Timed Unit use 78 Visits (60 Patients)
0 5
10 15 20 25 30
Nu
mb
er
of
Pati
en
ts
Town
Location of Patients
Outcomes continued
32%
68%
Patient Gender n=60
GENDER M GENDER F
58% 42%
Home Circumstances n=60
LIVES ALONE
DOES NOT LIVE ALONE
47% 53%
Source of referral N=60
Referral location A & E
Referral location AU1 18%
70%
9%
3% Package of Care
n=60
Yes No Avenue Unknown
Evaluation
13%
85%
2%
Dementia Diagnosis n=60
Yes No Unknown
• Use of care measure patient feedback tool.
• Use of IoRN – to identify level of need – pre and post
intervention.
Cost
• Approximately £596 per patient.
Final Thoughts
Short-term care/daily support
HCSW – additional resource
Avenue
USCB request
TOC at back door from MoE wards