How local partnerships to improve urgent and emergency care have impacted delayed transfers of care from hospitals in England: an analysis based on a synthetic control estimation method

Malisauskaite, Gintare; Jones, Karen C.; Allan, Stephen; Roland, Daniel; Birks, Yvonne; Baxter, Kate; Gridley, Kate

doi:10.1136/bmjopen-2021-054568

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…DTOCs arise at the interface between hospital and social care and can be reduced by local partnerships and discharge planning [ 93 ]. They create an increased length of stay.…”

Section: Defining An Optimum Hospital Sizementioning

confidence: 99%

Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

Jones

2023

IJERPH

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Based upon 30-years of research by the author, a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 people is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem, a new approach to bed modeling has been developed that plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with a higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence of overutilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, and surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.

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“…DTOCs arise at the interface between hospital and social care and can be reduced by local partnerships and discharge planning [ 93 ]. They create an increased length of stay.…”

Section: Defining An Optimum Hospital Sizementioning

confidence: 99%

Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

Jones

2023

IJERPH

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“…Te current paper builds on the previous analysis [14] by providing a more precise identifcation of the extent each LA was exposed to and potentially benefting from hospitals that were UEC vanguard partners. DTOC breakdowns by sector responsible and by reason for delay additionally help refne the explanation regarding which reasons for the delay were particularly responsive to UEC vanguards, this ofers better insight as to why this programme may have been successful in reducing DTOC.…”

Section: Discussionmentioning

confidence: 98%

“…Te current paper builds on the authors' previous work [14] to look further into the relationship between the UEC vanguard and DTOC. Previously the authors have used a synthetic control estimation method whereby 29 local authorities (LAs) identifed to be involved in the UEC vanguard were averaged into a single "treated" unit and compared with a unit created using data from non-UEC English LAs to estimate the impact of UEC vanguards on DTOC days.…”

Section: Introductionmentioning

confidence: 99%

“…Te authors found no indication of UEC participant sites having lower DTOC rates before the initiation of vanguards. Te authors highlighted that the evidence indicated a sizeable statistically signifcant impact of UEC vanguards on DTOC, however, more research would be required to explain the underlying reasons for this relationship [14]. Consequently, further analysis was conducted to account for the fact that DTOC rates at the LA level are calculated based on the geographical residence of patients, while hospital services that observe the UEC practices applied may receive patients from many LAs.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

Malisauskaite

Jones

Lau

et al. 2023

Health & Social Care in the Community

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This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC.

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“…DTOCs arise at the interface between hospital and social care and can be reduced by local partnerships and discharge planning [93]. They create increased length of stay.…”

Section: Delayed Transfers Of Care (Dtoc)mentioning

confidence: 99%

Addressing the Knowledge Deficit in Hospital Bed Planning, Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

Jones

2023

Preprint

View full text Add to dashboard Cite

Based upon 30-years of research by the author a new approach to hospital bed planning and international benchmarking is proposed. The number of hospital beds per 1000 population is commonly used to compare international bed numbers. This method is flawed because it does not consider population age structure or the effect of nearness-to-death on hospital utilization. Deaths are also serving as a proxy for wider bed demand arising from undetected outbreaks of 3000 species of human pathogens. To remedy this problem a new approach to bed modelling has been developed which plots beds per 1000 deaths against deaths per 1000 population. Lines of equivalence can be drawn on the plot to delineate countries with higher or lower bed supply. This method is extended to attempt to define the optimum region for bed supply in an effective health care system. England is used as an example of a health system descending into operational chaos due to too few beds and manpower. The former Soviet bloc countries represent a health system overly dependent on hospital beds. Several countries also show evidence for over-utilization of hospital beds. The new method is used to define a potential range for bed supply and manpower where the current most effective health systems currently reside. The method is applied to total curative beds, medical beds, psychiatric beds, critical care, geriatric care, etc., and can also be used to compare different types of healthcare staff, i.e., nurses, physicians, surgeons. Issues surrounding the optimum hospital size and the optimum average occupancy will also be discussed. The role of poor policy in the English NHS is used to show how the NHS has been led into a bed crisis. The method is also extended beyond international benchmarking to illustrate how it can be applied at a local or regional level in the process of long-term bed planning. Issues regarding the volatility in hospital admissions are also addressed to explain the need for surge capacity and why an adequate average bed occupancy margin is required for an optimally functioning hospital.

show abstract

How local partnerships to improve urgent and emergency care have impacted delayed transfers of care from hospitals in England: an analysis based on a synthetic control estimation method

Cited by 4 publications

References 22 publications

Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

Addressing the Knowledge Deficit in Hospital Bed Planning and Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

Addressing the Knowledge Deficit in Hospital Bed Planning, Defining an Optimum Region for the Number of Different Types of Hospital Beds in an Effective Health Care System

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