Introduction

HomeLink Healthcare has been working with the NHS to help deliver and evaluate Early Supported Discharge and Virtual Ward services. These services, designed to improve patient flow, provide care at home for patients who would otherwise have had to remain in hospital.

Initial evaluations of these services have demonstrated the delivery of safe, efficient and cost-effective capacity all year round and excellent patient experience. As a result of these benefits and positive findings, HomeLink Healthcare is offering a limited number of free feasibility studies* to NHS organisations to illustrate the benefits that Early Supported Discharge and Virtual Wards could have for them.

Background

Acute NHS Hospital Trusts have identified several challenges that consistently impact on patient flow.
These include:

  • Lack of same-day availability of community services.
  • Delays in the commencement of packages of care.
  • Community services are not always available in Care Homes.
  • Delays in access to negative pressure therapy.
  • Availability of same-day IV Therapy at Home services.
  • Patients not routinely discharged at weekends.
  • Patients not routinely discharged before midday.
  • Inequality of access to community care.

Service Setup

To address the challenges that had an impact on patient flow, the Acute Trusts recognised that there was a need for external specialist knowledge.

As a result, they partnered with HomeLink Healthcare, a CQC registered company experienced in home-based clinical care, to deliver and evaluate Early Supported Discharge and Virtual Ward services.

In each case a team from the Trust and HomeLink Healthcare collaborated to develop the core features of the service:

  • On-site presence from a senior clinician from HomeLink Healthcare, to assess patients, liaise with staff, coordinate with hospital teams and safely manage transfers home for the patient.
  • Integration of the new service with existing discharge processes and teams.
  • Proactive identification of patients suitable for Early Supported Discharge or the Virtual Ward services.
  • Attendance by the HomeLink Healthcare clinicians at Multi-disciplinary Team meetings (Red to Green) and Bed Meetings.
  • Same day referral, assessment and discharge home.
  • Avoidance of duplication of existing community services.
  • Building confidence with hospital clinicians.
  • 24-hour access to On-Call Support.

HomeLink Healthcare and the Acute Trusts developed and tested four new patient pathways for Early Supported Discharge and Virtual Ward services, all available on the day of referral:

  1. Bridging Packages of Care and Home Settling until local social services become available.
  2. Care at home of complex wounds and the provision of negative pressure therapy.
  3. Intravenous Antibiotic Therapy at home.
  4. Community-based Physiotherapy in tandem with Bridging Packages of Care.

Mobilisation

A mobilisation period preceded the start of service delivery. During this period a joint team from the Acute Trusts and HomeLink Healthcare built strong working relationships and mutually developed the:

  • Governance and safety protocols.
  • Referral and discharge processes.

Whilst ensuring that they also focused on their:

  • Engagement with the clinical and operations teams in the hospital and the community.
  • Agreement of patient pathways.

Key Performance Indicators of both quality and quantitative measures are agreed during mobilisation and put in place to evaluate the effectiveness of the service. Data gathered from the HomeLink Healthcare information systems is analysed and fed into an automated performance reporting system. These reports are utilised during meetings to review and inform service development and are shared with local NHS commissioning organisations.

Key Findings

Data taken from various sources has highlighted numerous benefits for both the Acute Trust and patients.

Overall

Evaluation data from the services has indicated that hospital flow has improved, and the length of overall hospital stays has reduced.

Patient Experience

Patient experience responses** have been overwhelmingly positive. Of all the patients cared for in our services, 100% of them would recommend HomeLink Healthcare to their friends and family.

** measured through a patient self-reported questionnaire combining quantitative and qualitative questions.

Stakeholder Feedback

Evaluation and feedback from our key stakeholders have been positive. Value is placed upon having HomeLink Healthcare fully integrated with hospital wards and teams.

Impact

The length of time patients received care at home varied between pathways, and was influenced by the availability of other health and social community services, for example:

  • Patients receiving Intravenous Antibiotics at home averaged 20 days
  • Patients receiving Bridging Package of Care averaged 5 days

Early Supported Discharge and Virtual Ward services could save a typical large NHS Acute Trust (800 – 1,200 beds) approximately 11,000 Bed Nights annually. The equivalent to a 30-bed hospital ward.

Service evaluations have demonstrated that the average cost of treating a patient at home is lower than the in-patient bed cost, benchmarked at between £250 – £300 per day.

Summary

Early Supported Discharge and Virtual Ward services deliver a safe, efficient and effective way to provide cost-efficient capacity all year round by improving patient flow and releasing in-patient beds. Evaluation of the services has demonstrated benefits to the Acute Trusts and patients including:

  • Enabling safe, same day transition from hospital to home including weekend discharges.
  • Offering patients choice.
  • Supporting innovation (Red to Green) and as an accelerant for change.
  • Addressing inequalities in access to community-based care.
  • Easing pressure on beds by improving patient flow.
  • Reducing the need for Escalation Beds.
  • Demonstrating organisational and system benefits for delivery at scale.

Next Steps

HomeLink Healthcare is ideally placed to work with Acute Trusts to help them deliver the benefits of Early Supported Discharge and Virtual Wards.

We welcome the opportunity to work with you and further explore how HomeLink Healthcare services can improve capacity and flow in your hospital through:

  • Our free feasibility study offer.*
  • A pilot to test the effectiveness of Early Supported Discharge and Virtual Wards.

*A limited number of free feasibility studies are being offered to NHS organisations by HomeLink Healthcare. In these studies, we will work alongside hospital teams to establish the extent of the opportunity for Early Supported Discharge / Virtual Ward through analysis of CUR (Clinical Utilisation Review) data or conducting ward surveys. Using this information in our modelling tools we will produce an outline business case bespoke to the Trust.

To start the conversation please contact:Andy Collett at andy.collett@homelinkhealthcare.co.uk or 07984 570844

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