Dorset County Hospital NHS Foundation Trust

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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 - PowerPoint PPT Presentation

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<ul><li><p>Dorset County Hospital NHS Foundation TrustSeven Day ServicesWorking in partnership to reduce avoidable admissionsAcute Hospital at Home</p><p>Patricia Miller, Acting CEO, DCHFTShane Cowan, Urgent and Emergency Care Manager, DCHFTRuth Davis, Assistant Commissioning Manager, Dorset County Council</p></li><li><p> Trust ProfileDorset County Hospital is a small DGH located in a rural community. West Dorset catchment population of c240,000</p><p>The Trust provides Renal Service to Dorset and parts of Somerset covering population of around 800,000.</p><p>Inpatient bed base 368 including Maternity; workforce - 3,000 multi-professional staff.</p><p>Good relationships with health and social care; CCG support for innovation.</p><p>Focus on integrated care pathways and expansion into community.</p><p>Annual turnover of 150m</p></li><li><p>ChallengesServes a number of rural localities. Significant travelling distances for patients to visit the hospital for treatment26% of the population is of retirement ageElderly patients have multiple long term conditions leading to frequent readmissions and high care needs in hospital and the communitySome Models of Care are very traditionalFinancial sustainabilityRecruitment and retention in acute key specialties and community Lack system or pathway integration</p></li><li><p>What is Acute Hospital at HomeThree areas of service:</p><p>Acute hospital at Home DaytimeRoaming Night ServiceAlternative Offer</p></li><li><p>Acute Hospital at Home DaytimeThe Service is Consultant led and enables patients to remain at home and receive inpatient care from a multi disciplinary teamThe 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 communityPatient cohort using this service includes conditions such as COPD, bronchiectasis, IV Therapies, frail elderly with multiple LTCs </p></li><li><p>Acute Hospital at Home DaytimeThe Service has during its inception faced a number of challengesRecruitment 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</p></li><li><p>Acute Hospital At Home DaytimeHandovers for night team comprehensive handover was essential to both the site team and the roaming night team </p></li><li><p>Roaming Night Service2 carers covering a geographical area</p><p>Supports the Alternative Offer and Acute Hospital at Home Services</p><p>Links to ED, SWAST, Careline and 111 if required </p><p>Case Study Ms &amp; Ms F</p></li><li><p>Alternative OfferNational Care home capacity expanding Dorset admissions similar pattern46% placements directly from a hospital settingCase studies: Ms S &amp; Ms B</p></li><li><p>What have we achieved?</p><p>KPIBaselineObjectiveAchievedEmergency length of stay6.85.85.8Residential home placements2364 (3 nursing, 1 residential)increased Consultant presence/senior decision making10 hours weekdays12 hours weekdays12 hours weekdays6 hours 12 hours 12 hours weekendsweekendsweekendsPatient experienceNA95%95%Emergency admission reviewed by Consultant within 14 hours100% Within 24 hours100% within 14 hours100% within 14 hoursReduction in beds NA10 beds10 beds</p></li><li><p>Softer targets for improvementPatient 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 admissionPartnership working between health and social care has been strengthenedIntegration has been the key result, with health and social care providing seamless care for patients</p></li><li><p>Next stepsService has been identified by NHS England Innovations Team as good practice.</p><p>Service funded recurrently by Dorset CCG</p><p>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.</p><p>Alternative offer to be expanded to cover the county </p><p>*</p></li></ul>

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