Transcript Who’s in the beds: surveying and the aftermath Dr Paul Forte Balance of Care Group and Centre for Health Planning & Management, Keele University, UK.

Who’s in the beds:
surveying and the aftermath
Dr Paul Forte
Balance of Care Group
and
Centre for Health Planning & Management,
Keele University, UK
Typical questions
• ‘We want to improve the flow of patients through
acute beds’
– what alternative care processes are there?
– which types of patients are these suitable for?
– what are implications for the types of resources
required such as staff and beds/ places?
– when might we achieve this by?
– who pays?
Data required
• Referral route into the hospital and health/ social
care system
• Reasons for admission; diagnosis; risk factors
affecting discharge
• Alternatives to acute admission - and to
continued presence in acute beds
• Discharge arrangements and factors delaying this
process
Pre-survey
• Finding out the true extent of local ‘whole
systems’ working
• Gaining acceptance of the methodology
• Identifying extent of the survey
• Recruitment and training of surveyors
• Addressing issues of patient and information
confidentiality
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Number of patients
Who are the patients?
Admission reason (n = 479)
140
120
100
80
60
40
20
0
Community
Addenbrookes
Alternatives to acute admission on
day of the survey
A lte r n a tiv e s fo r p a tie n ts a d m itte d
o u ts id e A E P c r ite r ia (N = 5 8 )
40
N o o f p a ti e n ts
35
30
25
20
15
10
5
0
H om e based
c a re
N o n A c u te B e d
M e n t a l H e a lt h
C a re
Alternatives to acute care on day of
survey
Preferred Alternatives for Selected Patients
(Acute = 107, Community = 67)
100
90
80
No of Patients
70
60
50
Acute
40
Community
30
20
10
0
Home based
care
Mental Health Non-acute Bed
Care
- no rehab
Rehab Bed
Other
Post-survey
• Database input, initial analyses, surveyor
interpretation workshops
• Four weeks later: data from local information
systems to gain longitudinal perspective (length
of stay, discharge destinations)
• Capacity analyses with local workshops and
presentations on the implications of the results
and potential forward strategies
Future care trends
• More ‘active rehabilitation’ in the community:
hospitals, care homes, clients’ own homes
• Blurring of boundary between health and social care
environments
• More flexibility and devolution of tasks within and
between care professions
• More active ‘upstream’ management
– chronic disease management
– risk management of frail elderly in the community
– health promotion
Capacity ‘cascade’
Figure 6
Potential Changes in Care
Location
Community
Care
19
22
Heatherwood &
Wexham Park
Hospitals
22
Non-acute
Beds
24
32
Care Homes
Potential consequences
• Intermediate Care services have tended to
focus attention on patients who can be
rehabilitated quickly
• Community-based services could broaden
scope to ‘slow stream’ rehab patients
• More creativity both in locations for care and
in the care processes themselves comes with
better knowledge about patients
Community care workforce
implications – by dependency
Weekly Input per Care Package
Input required to meet demand previously met in hospitals
19
12
10
41
Additional WTE to meet additional demand
Additional WTE introduced since survey date
Dependency Level
High
Medium
Low
Therapy
Nursing Care Assistants
Hours per week Visits per week Hours per week
7
7
21
3
3
10.5
1
3
High
Medium
Low
Total per week
Capacity/WTE p.w.
WTE
133
36
10
179
25
7.2
133
36
0
169
40
4.2
399
126
30
555
30
18.5
New services WTE
13.8
5.1
n/a
By staff grade and location
Grade
Senior 1
Senior 2
Assistant
Clerical
Total
Day
Community
Current Outpatient Hospital Inpatient Addition
0.5
0.5
0.62
0.31
1.5
1.5
0.83
1
0.5
0.22
0.78
2.22
2.78
0.83
1.62
0.81
Total
1.93
3.83
1.5
1
8.26
Enabling environments for new directions
• Organisational issues:
– partnership working, joint appointments
• Information issues:
– common definitions, data sharing
• Engaging clinicians:
– harnessing clinical drive
– facilitating clinical engagement
Reflections
• Getting beyond local ‘blame cultures’ and
cynicism
• Making ‘whole-systems’ more than a buzz-word
• Difficulties of ‘following through’ – takes time for
local health and social care economies to absorb
and act upon messages
• Targeted follow-up work on specific issues using
survey data as a starting point – populating the
Balance of Care model