Discharge to assess: transforming the discharge process of frail older patients

Abstract

The 2012 Royal College of Physicians report Hospitals on the edge is clear that 'decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their own service - are organised'. This paper describes a service redesign in which we have gained learning and experience in two areas. Firstly, a description of measured improvement by the innovation of redesigning the traditional hospital-based assessment of frail older patients' home support needs (assess to discharge) into their own home and meeting those needs in real time (discharge to assess). In combination with the formation of a collaborative health and social care community team to deliver this new process, there has been a reduction in the length of stay from completion of acute hospital care to getting home (from 5.5 days to 1.2 days for those patients that require support at home). Secondly, the methodology through which this has been achieved. We describe our translation of a Toyota methodology used for the design of complex cars to use for engaging staff and patients in the design of a healthcare process.

Keywords: Discharge to assess; process design; quality improvement; statistical process control.

Fig 1.

The ‘Big Room’ translated from Toyota Oobeya. Reproduced with permission from The Health Foundation.

Fig 2.

Reducing patient wait for active recovery from a hospital bed. AR = Active Recovery; CICS = Community Intermediate Care Service; STIT = Short Term Intervention Team