whos in the beds: surveying and the aftermath dr paul forte balance of care group and centre for...
TRANSCRIPT
Who’s in the beds: surveying and the
aftermath
Dr Paul ForteBalance of Care Group
andCentre 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
Who are the patients?
Admission reason (n = 479)
0
20
40
60
80
100
120
140
Nu
mb
er
of
pa
tie
nts
Community
Addenbrookes
Alternatives to acute admission on day of the survey
Alternatives for patients admitted outside AEP criteria (N=58)
0
5
10
15
20
25
30
35
40
Home basedcare
NonAcuteBed Mental HealthCare
No
of
pa
tie
nts
Preferred Alternatives for Selected Patients(Acute = 107, Community = 67)
0
10
20
30
40
50
60
70
80
90
100
Home basedcare
Mental HealthCare
Non-acute Bed- no rehab
Rehab Bed Other
No
of P
atie
nts
Acute
Community
Alternatives to acute care on day of survey
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
Heatherwood &Wexham Park
Hospitals
Care Homes
CommunityCare
Non-acuteBeds
19
22
22
2432
Figure 6 Potential Changes in Care Location
Capacity ‘cascade’
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
Therapy Nursing Care AssistantsWeekly Input per Care Package Dependency Level Hours per week Visits per week Hours per week
High 7 7 21Medium 3 3 10.5Low 1 3
Input required to meet demand previously met in hospitals19 High 133 133 39912 Medium 36 36 12610 Low 10 0 3041 Total per week 179 169 555
Additional WTE to meet additional demand Capacity/WTE p.w. 25 40 30WTE 7.2 4.2 18.5
Additional WTE introduced since survey date New services WTE 13.8 5.1 n/a
By staff grade and location
Grade Current OutpatientDay
Hospital InpatientCommunity
Addition TotalSenior 1 0.5 0.5 0.62 0.31 1.93Senior 2 1.5 1.5 0.83 3.83Assistant 1 0.5 1.5Clerical 0.22 0.78 1Total 2.22 2.78 0.83 1.62 0.81 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