Improving hospital discharge pathways in East London Barking and Dagenham, Havering, and Redbridge (BHR): Introducing a simplified discharge model to support patients to return home when they no longer need to remain in hospital Situation Congested hospitals struggle to deliver the best care for patients leading to poor outcomes and negative patient experiences. Unnecessary long stays in hospital increase the risk of harm to the patient from deconditioning, DVT, infection and loss of independence Reducing patient length of stay is a national priority, and all hospital Trusts in England have been tasked with reducing their number of long stay patients by 40% in 2019-20. For BHR, this means 57 fewer long stay patients across BHR Hospitals sites. There is an intense focus within BHR to deliver the system changes needed to make significant inroads into reducing long lengths of stay in order to free beds which in turn provides capacity to avoid A&E’s breaching the 4 hour wait time limits. Services that support BHR patients to return safely home when they no longer need hospital treatment have grown organically over time, resulting in a complex and disjointed landscape of discharge pathways. The BHR local system has already embarked on a number of improvement initiatives aimed at improving current patient flow, particularly discharges through Queen’s Hospital. Using “Home First” as its guiding principle, the BHR system wishes to introduce a best practice model to reduce Length of Stay and associated complications for patients stranded in hospital Scope of impact Barnet Enfield Haringey Camden Islington City Barking and Dagenham Hackney Havering Newham Redbridge Tower Hamlets Waltham Forest Croydon Richmond Wandsworth Kingston Merton Sutton Brent Ealing H&F Harrow Hounslow K&C Westminster Hillingdon Lambeth Bromley Bexley Greenwich Lewisham Southwark BHR HLP has supported LLOS (Long Length of Stay) Reviews HLP has supported MADEs (Multi Agency Discharge Events) HLP has supported both LLOS Reviews and MADEs What are we doing? Healthy London Partnership’s UEC Programme were asked to provide dedicated improvement support for the BHR Local System, focusing on embedding a “Home First” approach within its hospital discharge pathways We are working in partnership with key local stakeholders including BHR Clinical Commissioning Groups (CCGs), BHR Hospitals, the London Boroughs of Barking & Dagenham, Havering and Redbridge, and North East London NHS Foundation Trust (NELFT) We also work alongside ECIST (Emergency Care Intensive Support Team), who are providing support to improve Emergency Department performance at BHR Hospitals. This work began in March 2019 and is on-going What has HLP delivered to date? A comprehensive review of existing discharge improvement project plans completed within the BHR system to ensure they are evidence-based, robust, realistic, and contribute towards reducing harm and shorter lengths of hospital stay. Developing a structured approach to collaboratively map discharge pathways and processes, supporting the local system to create a single, agreed ‘version of the truth’ across all partners and develop a shared vision for improvement. Identification of a critical path towards introducing a new, simplified model of discharge based on national best practice Discharge To Assess (Home First) principles. The Discharge To Assess model will support patients to return to their home or another community setting once they no longer need acute hospital care, and ensures that assessments for on-going care and support needs are undertaken in the most appropriate setting and at the right time for the patient. 12-week evaluation of the Havering Care Homes Trusted Assessor pilot, a pioneering service to reduce length of stay for patients being discharged to care homes. Extensive stakeholder engagement with health and social care partners to understand current challenges, including regular attendance and support at weekly ward-based Long Length of Stay (LLOS) reviews at Queen’s Hospital. What was the feedback from key stakeholders? BHR CCG’s Deputy Director of Unplanned Care said: “The BHR system has received excellent support from HLP over the last few months. The HLP team have provided clear structure and supported the system with project management, stakeholder engagement and cross-organisational working. The system could not have progressed our work on discharge pathways without this support and it is highly valued by system partners.” To find out more, please contact: Eileen Sutton eileensutton@nhs.net @healthyLDN