Transcript ea 1.3 v2 dorset

Dorset County Hospital NHS
Foundation Trust
Seven Day Services
Working in partnership to reduce avoidable
admissions
Acute Hospital at Home
Patricia Miller, Acting CEO, DCHFT
Shane Cowan, Urgent and Emergency Care Manager, DCHFT
Ruth Davis, Assistant Commissioning Manager, Dorset
County Council
Trust Profile
• Dorset County Hospital is a small DGH located in a rural
community. West Dorset catchment population of c240,000
• The Trust provides Renal Service to Dorset and parts of
Somerset covering population of around 800,000.
• Inpatient bed base – 368 including Maternity; workforce 3,000 multi-professional staff.
• Good relationships with health and social care; CCG support
for innovation.
• Focus on integrated care pathways and expansion into
community.
• Annual turnover of £150m
Challenges
• Serves a number of rural localities. Significant
travelling distances for patients to visit the hospital
for treatment
• 26% of the population is of retirement age
• Elderly patients have multiple long term conditions
leading to frequent readmissions and high care
needs in hospital and the community
• Some Models of Care are very traditional
• Financial sustainability
• Recruitment and retention in acute key specialties
and community
• Lack system or pathway integration
What is Acute Hospital at Home
Three areas of service:
• Acute hospital at Home Daytime
• Roaming Night Service
• Alternative Offer
Acute Hospital at Home Daytime
• The Service is Consultant led and enables
patients to remain at home and receive
‘inpatient’ care from a multi disciplinary team
• The Service is supported by Consultant
delivered service across the hospital and
community seven days per week.
• The initial service provided ten virtual beds in
the community
• Patient cohort using this service includes
conditions such as COPD, bronchiectasis, IV
Therapies, frail elderly with multiple LTCs
Acute Hospital at Home Daytime
The Service has during its inception faced a number of
challenges
• Recruitment to fixed term posts during the pilot
phase. This was managed by offering secondments
• Residential Home in Reach has proved difficult as
they are not registered for nursing care. We are
currently working with the CCG to address this.
• Drug management – ensuring robust clinical
governance has been challenging particularly in the
absence of electronic prescribing
Acute Hospital At Home Daytime
• Handovers for night team – comprehensive handover
was essential to both the site team and the roaming
night team
Roaming Night Service
• 2 carers covering a geographical area
• Supports the Alternative Offer and Acute Hospital at
Home Services
• Links to ED, SWAST, Careline and 111 if required
• Case Study – Ms & Ms F
Alternative Offer
• National Care home capacity expanding – Dorset
admissions similar pattern
• 46% placements directly from a hospital setting
• Case studies: Ms S & Ms B
What have we achieved?
KPI
Baseline
Objective
Achieved
Emergency length of stay
6.8
5.8
5.8
Residential home placements
23
6
4
(3 nursing, 1 residential)
increased Consultant presence/senior
decision making
10 hours weekdays 12 hours weekdays 12 hours
weekdays
Patient experience
6 hours
weekends
NA
12 hours
weekends
95%
12 hours
weekends
95%
Emergency admission reviewed by
Consultant within 14 hours
100% Within 24
hours
100% within 14
hours
100% within 14
hours
Reduction in beds
NA
10 beds
10 beds
Softer targets for improvement
• Patient experience, especially for vulnerable
patients has improved. Experienced Based
Design used to ensure service was patient
centred.
• Care closer to home was achieved particularly for
frail elderly at risk of hospital admission
• Partnership working between health and social
care has been strengthened
• Integration has been the key result, with health
and social care providing seamless care for
patients
Next steps
• Service has been identified by NHS England
Innovations Team as good practice.
• Service funded recurrently by Dorset CCG
• Acute Hospital at Home Service to be expanded to 15
beds admitting frail elderly and increased further
during next winter. Decision made not to close these
beds as emergency admissions rising by 5% year on
year. However winter escalation capacity has been
reduced from 26 beds to 13 beds.
• Alternative offer to be expanded to cover the county