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Reducing Delayed Transfers of Care

Challenge

Delayed Transfers of Care (DTOCs) across England have been increasing and according to Unify data in May 2017, the lack of nursing and residential care home bed availability and patient choice collectively accounted for 37% of all reported DTOCs.

In order to make spare care home bed capacity instantly visible to discharge teams etc, this project aimed to use web technology to help reduce this 37% of reported DTOCs and so free up beds to help improve A&E performance and reduce winter pressures.

The project also aimed to reduce the significant amount of time routinely wasted by discharge teams (NHS and Local Authority) spent telephoning care homes to find spare bed capacity a few days prior to discharging patients, and then having to repeat this process shortly before the actual patient discharge.
Reducing Delayed Transfers of Care

Tasks

NECS worked with NHS England (North region), care home providers, Clinical Commissioning Groups and other stakeholders to develop a web-based portal to make live bed state/capacity quickly searchable and instantly visible to all users. NECS recognised the need from the outset to make the portal very simple to use and minimise the burden on care homes to encourage them to keep their bed state up-to-date. The overriding imperative was to ensure the bed state information was readily accessible by hospital discharge teams when it was most needed. The project group acknowledged the existence of other commercial systems but these were discounted principally due to licensing /infrastructure costs, lack of flexibility and/or ability to mobilise at pace. The operational problem exists now and we needed a rapid, cost-effective solution putting place.

NECS developed the web portal and NHS Tameside and Glossop CCG in Manchester agreed to lead the pilot. The Portal was designed for NHS and local authority users to quickly search for spare capacity using filters such as Postcode of interest, Bed Type, CQC Rating. The care homes that matched the search criteria with spare capacity are instantly displayed in increasing distance from the specified postcode and relevant information is presented to the user enabling them to make contact with the care home directly to secure the spare bed.

We also included a ‘Contact Directory’ to help users easily connect with NHS providers, Care Homes, Local Authorities and CCGs Every registered organisation has at least one user with ‘Approver’ permissions so they can add and remove users’ access to their care home and remain in control of their own demographic and capacity information. Users can also reset forgotten passwords themselves which minimises the burden on system administrators. To ensure consistent interpretation and monitoring of the data between stakeholders, NECS developed standard template reports and provided users with the ability to compare two variables of their choice – for example CCG by Bed Type or Local Authority by Care Home etc. Also, during the project, STPs were gaining momentum so the NECS team ensured the Portal could report spare bed capacity and bed utilisation at varying levels from STP level to individual care home level. The Portal also tracks bed capacity over time too which helps with market oversight and future planning & contracting for bed capacity.

Nominating a system champion worked really well in Tameside as they could confidently provide face-to-face or remote support. They also became a strong advocate of the web Portal and could readily promote the benefits to care homes and other stakeholders. To aid awareness and communication, videos of the introductory presentation and full online system demonstration were made available via the Portal and on YouTube. Once registered in the Portal, users have access to an online user-guide, training requirements are minimal and typically takes no longer than 15 minutes. We are currently mobilising across South Yorkshire and Bassetlaw STP encompassing five CCGs and around 500 care homes. Being web-based, the Live Bed State Portal is entirely scalable and can be implemented at pace.

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The Care Home Live Bed State Web Portal has helped to identify capacity within care homes quickly and easily and saves the time spent on telephoning care homes to establish capacity. Since we launched the Portal in April 2017 the current uptake (July 2017) of care homes using the system is 61%. This number is increasing each month and as more care homes come online more capacity will get added to the Portal providing even more options to discharge teams and patients. The data supports the understanding that there is a shortage of general nursing and dementia nursing capacity and as such provides further evidence to support work to improve this position. The tool also supports work taking place to reduce the overall level of DToCs.

Cara Pursall

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Results

In isolation it is very difficult to prove cause and effect in terms of the impact that the Portal has had on the level of reported DTOCs. Making this capacity information available to the discharge teams is the key learning point here and it’s definitely the right thing to do in addition to other management solutions.

At the time of writing, one of the many reports from the Portal shows that the 34 care homes registered in the Portal across Tameside are currently declaring a maximum capacity of 1489 beds, 137 of which are empty – equivalent to a 91% utilisation. We can quickly break this down by bed type and care home and through the powerful reporting capability, easily show the bed state at a range of levels from STP, NHS region, NHS sub-region, Local Authority, CCG, Care home organisation, Care home and bed type levels.

Feedback has been really positive: Discharge teams are reporting the Portal is very simple to use and quickly helps them to find spare beds that meets their search criteria, saving them lots of time ‘ringing around’. Feedback from care homes is also very positive too with the overwhelming majority finding it extremely quick and simple to update their bed state. The portal has also been used to help show patients and families the options available to aid faster discharge.

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