Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?

Jeffery, Stuart; MacInnes, Julie; Bertini, Lavinia; Walker, Susie

doi:10.1108/jica-02-2022-0018

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…The post-2020 evidence regarding the national policy’s impact is limited, but it does suggest variations in approaches, emphasising the importance of single access points, integrated teams, and the need for increased community capacity, 7 all of which were echoed by this study. Additionally, the study’s pilot project 8 found benefits in terms of staff satisfaction and working conditions however these were not strong themes in this current study.…”

Section: Discussionmentioning

confidence: 61%

“…They suggested that the funding of care for the initial post discharge period was helpful, partnership working enabled good relationships, adaptability of workforce was present and that systems were less risk averse than before. In addition, the pilot study to this project, 8 which focused on the experiences of hospital staff, showed benefits to the quadruple aims of healthcare improvement (improved quality, efficiency, wider health benefit and staff satisfaction 9 ), particularly around staff satisfaction and working conditions with staff reporting enhanced autonomy and widening skill sets.…”

Section: Introductionmentioning

confidence: 99%

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Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

Jeffery,

Monkhouse,

Bertini

et al. 2023

BMJ Open Qual

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BackgroundDischarge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England.MethodsWe interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights.Results62 specific enablers and blockers to effective D2A practice emerged.DiscussionThese findings supported the development of a comprehensive service improvement toolkit.ConclusionFive recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.

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Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

Jeffery,

Monkhouse,

Bertini

et al. 2023

BMJ Open Qual

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What Interventions have been used in the UK in response to Winter Pressures? Mapping review of Studies/Initiatives relating to Discharge Planning and/or Integrated Care

Cantrell

Chambers

2023

Preprint

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Background: Winter pressures are a familiar phenomenon within the NHS and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review will focus on interventions or initiatives in relation to winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods: We conducted a mapping review of UK evidence published 2018-2022. Initially, we searched MEDLINE, HMIC, Social Care Online, Social Sciences Citation Index and Kings Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar. For each taxonomy heading we produced a table with definition, findings from research studies, local initiatives and systematic reviews, and evidence gaps. Results: The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions: Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and Hospital at home interventions are heavily used and well-supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations: Time limitations for completing the review constrained the time for additional searches. This may carry implications for the completeness of the evidence base identified. Future work: Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame.

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Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study

et al. 2023

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Background Intermediate care (IC) services are models of care that aim to bridge the gap between hospital and home, enabling continuity of care and the transition to the community. The purpose of this study was to explore patient experience with a step-down, intermediate care unit in Buckinghamshire, UK. Methods A mixed-methods study design was used. Twenty-eight responses to a patient feedback questionnaire were analysed and seven qualitative semi-structured interviews were conducted. The eligible participants were patients who had been admitted to the step-down IC unit. Interview transcripts were analysed using thematic analysis. Findings Our interview data generated five core themes: (1) “Being uninformed”, (2) “Caring relationships with health practitioners”, (3) “Experiencing good intermediate care”, (4) “Rehabilitation” and (5) “Discussing the care plan”. When comparing the quantitative to the qualitative data, these themes are consistent. Conclusions Overall, the patients reported that the admission to the step-down care facility was positive. Patients highlighted the supportive relationship they formed with healthcare professionals in the IC and that the rehabilitation that was offered in the IC service was important in increasing mobility and regaining their independence. In addition, patients reported that they were largely unaware about their transfer to the IC unit before this occurred and they were also unaware of their discharge package of care. These findings will inform the evolving patient-centred journey for service development within intermediate care.

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Does a discharge to assess programme introduced in England meet the quadruple aim of service improvement?

Cited by 4 publications

References 16 publications

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement

What Interventions have been used in the UK in response to Winter Pressures? Mapping review of Studies/Initiatives relating to Discharge Planning and/or Integrated Care

Evaluating step-down, intermediate care programme in Buckinghamshire, UK: a mixed methods study

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