Right First Time – Redesigning how we discharge patients 7

days a week

DR ANDREW GIBSON, SHEFFIELD TEACHING HOSPITALS ANDSTEVEN HAIGH, RIGHT FIRST TIME PROGRAMME MANAGER

The Sheffield Vision for a 7 Day Service

Any Sheffield citizen’s experience of the health and social care system is a positive one, where their care needs are met at the right point and delay in accessing care is eliminated.By eliminating delay we will improve the outcome for the individual and make better use of the resources available.This is a whole system challenge

Sheffield in the National ContextCommon challenges with:• Length of Stay• Increasing rates of emergency admissions• Delayed discharges• High variation between weekday and weekend discharges• Challenges with the costs of long term care

THE VARIATION BETWEEN WEEKDAY AND WEEKEND CAPACITY HAS A SIGNIFICANT IMPACT ON EFFICIENCY AND EFFECTIVENESS

The Sheffield Approach• Ambitious Better Care Fund Plan (£280m)• Strong on partnership and relatively stable• Recognition that delays cause harm and that until we get the

system flowing we don’t know how big a hospital or community we need

IF WE REDUCE AVOIDABLE ADMISSIONS AND MINIMISE DELAYS WITH DISCHARGE THE POTENTIAL RESOURCE SHIFT TO THE COMMUNITY COULD BE EQUIVALENT TO A SIGNIFICANT NUMBER OF BEDS

The Sheffield 7 Day Challenge – the immediate focus

ACUTE CLINICAL STANDARDS – baseline assessment showed:1. Key gaps in workforce - • Junior doctors, nurse practitioners and AHPs• Consultant numbers to assess care needs in 1

hour for the sickest patients2. Key service issues – • Specialties are all at different levels of readiness

The Sheffield 7 Day Challenge – the immediate focus

COMMUNITY STANDARDS – or looking at the system as a wholeWe see whole system flow (Right Care, at the Right Time, with the Right Person) as being important to quality and safetyLEVELLING UP WEEKEND TO WEEKDAY DISCHARGE RATES IS IMPORTANT AS A MEASURE OF FLOW

The Sheffield Challenge – the immediate focus

What have we done?

• Switching from assess to discharge to discharge to assess

• Built capacity in the community (Active Recovery) to take discharges in 24 hours, 7/7

• Developed the for IC bed model to take transfers in 24 hours, 7/7

• Need to address long term care in the same way

Early D2A Testing Showed

Where are we now?

• D2A now established on GSM wards and will rollout to other medical specialties

• Active Recovery is down to a 24 hour wait (from a mean of 7 days)

• Discharging to off site beds at weekends is better

• DTOCs currently down to around 40 (not good but better then 125+ earlier this year)

What’s next for 7 day discharging?

COMMUNITY STANDARDS:• Stabilise D2A – making it business as usual• EVALUATION – is it better for patients, is it

affordable• Link to the Commissioners plans for the Better

Care Fund

What’s next for 7 day discharging?

ACUTE STANDARDS• Focus on the 91% that just go home – 1.58:1,

weekday to weekends • Identify the key service transformations

needed to enable this – ward processes, 7 day senior decision makers (doctors, nurses, therapists etc), transport, TTOs

• Move to morning discharging 7 days per week