Fast and Flexible: Therapy to improve flow and support early discharge from Hospital

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Background & Problem

Long hospital stays are bad for patients often resulting in poor outcomes and a greater need for care in the long term. Every day in hospital is also a precious day away from home for patients.

There is increasing recognition that early intervention (within 72 hours) with the elderly population significantly reduces length of stay and results in a reduced burden of care.

Gloucestershire Hospitals NHS Foundation Trust (GHFT) developed a vision for an ‘acute floor’ at GRH in order to improve flow and support the earlier discharge of elderly, frail patients from hospital. GHFT Therapy service is valued by the Trust and is seen as an essential enabler of the new model.

Aim

Therapy staff to discharge 40% of patients directly home from AMU following intervention from therapy and start therapy on AMU for 50% of patients who go on to be transferred to a specialty ward in 12 months.

Method

• Therapy teams remodelled to release dedicated therapy resource to AMU
• Wraparound Therapy team supporting Therapy resource to AMU
• Data collected and analysed regarding patients discharged directly home from AMU after intervention by Therapy and number of patients who had Therapy started on AMU prior to transfer to specialty ward

Results

• Senior clinical decision makers completing therapy assessments earlier, thereby reducing admissions and contributing to meeting 4 hour ED target
• Positive impact on length of stay for those patients transferred to the specialty wards by earlier intervention and seamless transfer to ward therapists
• An increasingly responsive service to meet the demand of bed pressures

Implications

Need to develop a strategy to:

• Empower staff in all roles to enable patients to engage in Activities of Daily Living and mobilisation, as soon as they present in hospital, reducing unnecessary bed rest.
• Change a ‘do for’ culture to a culture that fosters empowering those in our care and their families.
• Drive a ‘home first’ approach based on recognising that being in their familiar environment whenever possible optimises patient recovery and delivers better outcomes.
• Bring together an integrated team operating within a clear framework and with clear objectives in order to improve patient experience, decrease admissions and increase the ability to manage frailty on the Acute Floor.