Delayed Transfers of CareNursing Home Beds Review

Claire WalkerDivisional Manager – Integrated Clinical Services

Background• High DTOCs summer 2013• 20 to 37 individuals - 128 to 208 bed days PW• UCB agreed additional community bed capacity needed

in Brent and Harrow• NH beds to relieve Acute pressures• Target of max 10 DTOCs across 2 sites.• Beds available from August 2013 to 31st March 2014.

Project Details• Band 7 Acute Nurse/discharge coordinator• Managing a team of three occupational therapists.• Agreeing costs securing beds - 11 care homes and 1 B&B.• Assessment of patients suitability for transfer inc. medically

stable• Matching patients’ individual needs with the skills and

expertise of specific care homes.• Visiting and Liaising with care home staff• Daily MDT at the Trust and discharge planning • Managing issues from patients, families and care homes • Record keeping, managing invoicing and payments.

Team Role• Discharge planning • Comprehensive patient assessments • Daily maintenance rehabilitation • Referrals to social services and rehabilitation units.• Assessment of inpatients for DTOC beds.• Management of patient caseload. • Daily MDT meeting to discuss patient care and further

planning.• Managing minor issues/complaints from patients.

Whole System Efficiencies• 106 admissions 90 discharges by 31 March

Bed days used in NH:Responsible Aug Sep Oct Nov Dec Jan Feb Mar Total

CCG 38 162 241 342 375 349 435 479 2421

NWLH 0 100 252 277 317 315 233 291 1785

Total 38 262 493 619 692 664 668 770 4206

Average daily patient occupancy in care homes

- 8.73 15.9 20.63 22.32 21.42 23.86 24.84

Cost Benefit• Estimated cost efficiencies:

• NH project costs vs average acute bed day cost. This is a very crude measure.

Acute hospital bed cost

Team Costs Nursing Home bed cost (Average)

Cost efficiency gained

£1,261,800.00 £80,742.00 £378,540.00 £802,518

Length of Stay• LOS for 90 discharged patients was 34.87 days

• LOS if we discount the patients with complex pressure ulcers, housing issues and NWB patients was 29.9 days.

• NWB patients: 27 with LOS 49.85 days.

Discharge Destination and Readmissions

Discharge Destinations:

Readmissions to hospital

Home Hospital Housing Placement Rehab RIP Total

37 12 7 26 7 1 90

41.1% 13.3% 7.7% 28.8% 7.7% 1.1%  

Bowel Obstruction

Fractured NOF

Haematuria Infection – UTI/Chest

High Blood sugars

Total

1 1 2 7 1 12

Quality• No major quality issues raised• Patients discharged once stable for agreed destination• Complex rehab was not provided or intended• NWB post plaster removal received OPD or community

rehab once home• No comparison done between NH beds• Visiting staff progressed discharge issues