Delayed Discharges Definition & Data Recording Manual Updated version June 2010 Dot Jardine, NHS Greater Glasgow & Clyde Anne Stott, ISD Colin Gardiner, ISD

Outline How did we do it ? The Ready for Discharge date Infection Control Adults with Incapacity (AWI) Summary of Main Changes Summary of Main Coding and Data Changes Quarterly Timetable Monthly Timetable Example of New Excel File Layout Verification Form & Guidelines Code 9 Form & Guidelines

A short life working group was set up after Stirling event last year to update manual – (DRM subgroup) The group comprised local authority and health colleagues representing partnerships across Scotland How did we do it?

The updated manual clarifies the point in the Patient Journey when it is reasonable to set this date What needs to be in place to set the date Who needs to be involved to set the date Responsibilities of involved agencies within this process Recommended Timescales from when date is set There is only 1 date! The Ready for Discharge Date (RDD)

Infection Control Inclusion in the census of those patients who are in wards affected by infection control issues has been inconsistent across Scotland Two new X codes have been introduced: 26X Care home/facility closed-patient well but cannot be discharged at point of census 46X Ward closed - patient well but cannot be discharged/transferred due to closure at point of census

Adults with Incapacity (AWI) The updated manual clarifies the point in the patient journey when it is appropriate to use 51x From July 2010 narrative using the revised code 9 form must be supplied quarterly, to ISD and the Scottish Government in all cases where a patient has been delayed under code 51x for 6 months or longer, explaining reason for delay and action being taken.

Summary of Main Changes Policy Context: Highlights expected standard Throughout the document historical information has been taken out Manual makes clear that census relates to adults only - children’s specialties have been deleted Change in patients health circumstances, highlights decision made by the Consultant/GP EDISON - new section Section added on Mental Health patients covered by Mental Health legislation, if discharge appropriate they should be counted under the normal rules Manual now refers to Code 9 delays and not complex needs as some delays are considered complex but do not warrant the use of code 9 Front page: Addition of a review date

Summary of Main Coding & Data Changes New codes: –24F Awaiting place availability in care home (EMI/Dementia bed required) –41A Non-availability of NHS funding to purchase care home place –41B Non-availability of NHS funding to purchase any other care package –26X Care Home/facility closed – patient well but cannot be discharged at point of census –46X Ward closed – patient well but cannot be discharged/transferred due to closure at point of census –100 Reprovisioning/Recommissioning Codes which have been removed: –66 Disagreement between health and social Work. Out-of-area Indicator - new data item Monthly data submission: – has been brought in line with the quarterly data submission – 8 days

Quarterly Timetable (January, April, July and October) Action Responsible Organisation Milestone Collection of census data Hospital (NHS staff) 15 th of every month Completion of Code 9 form NHS Board/Social Work Quarterly census only Fully verified data and verification form sent to ISD via SWIFT NHS Board/Social Work 8 working days after census QA of data and resolution of any issues ISD 5 working days after receipt of data Issue of ‘early access’ copy to SG ASD ISD 8 working days before publication Publication of full reportISD Last Tuesday of the month following the census

Monthly Timetable (excluding January, April, July and October) Action Responsible Organisation Milestone Collection of census data Hospital (NHS staff) 15 th of every month Data and verification form sent to ISD via SWIFT NHS Board/Social Work 8 working days after census High level QA of data, resolution of any issues and production of tables ISD 5 working days after receipt of data Distribution of tablesISD 7 working days after receipt of data

Example of New Excel File Layout Hosp code CHI numberPostcodeLA Date of Birth Spec Date of referral for assessment Ready-for- discharge date Reason for delay at census point Out of Area S314H IV27FG1827/06/1969G126/05/200915/06/ DXYes S314H EH47DE1411/04/1929AB26/05/200915/06/200924B S226H EH234SR2004/11/1931AB02/03/200923/03/ X 2 columns only

Section 1 – NHS Board total (include code 9, secondary X code cases and all local authority partners you are submitting data for) NHS BoardTotal no. of cases No. of cases for code 9 and secondary X codes Date census taken Section 2 – Numbers for the Local Authority Partners that are verifying data locally (include code 9 and secondary X code cases) Local Authority Partners (code) Total no. of cases (including healthcare reasons & code 9 and secondary X codes) No. of cases with social work involvement (including code 9 and secondary X codes) No. of cases for code 9 and secondary X codes only Verification Form

Form Filling Guidelines (1) 1.Amend this form each month- add in your NHS Board name and the relevant census month 2.One form should be completed by each NHS Board and sent via SWIFT to ISD by the submission date for the census data. This form does not need to be signed 3.All delayed discharges as at the census date should be included on this form. This includes the code 9 and secondary X code cases. These cases will continue to be excluded from census totals and reported on separately, however, we still need to have these cases verified. Note that all numbers in the form should include code 9 and secondary X code cases should they exist 4.Section 1 – NHS Board total. This should include all cases within your area hospitals, including those for Local Authority Partners outwith your area

Form Filling Guidelines (2) 5.Section 2 – Local Authority Partners. Enter each Local Authority Partner that you will be submitting fully signed off data for. Note that the local authority codes should be entered in the first column 6.Section 3 – Other Local Authority Partners. This should only be the LA’s that are out with your NHS Board area 7.Cases that have healthcare reasons are not considered to have social work involvement. We do not ask Local Authority Partners to verify cases that do not have social work involvement, however, we would like all cases to be included on this form so that we can check this form matches to the data that is submitted 8.Please do not change the format or size of the word tables. If absolutely necessary rows can be added but under no circumstances should columns be removed

Section 1- Reason for inclusion under Code 9 and what is being done to facilitate discharge Patient ID – (First 5 Numbers of CHI):Agreed by:Date: LA codeDate of Admission: Date Ready for Discharge: ISD Code: Reason for DelayWhat arrangements are being made to facilitate discharge: Patient ID – (First 5 Numbers of CHI):Agreed by:Date: LA codeDate of Admission: Date Ready for Discharge: ISD Code: Reason for Delay:What arrangements are being made to facilitate discharge: Code 9 Form

Code 9 Guidelines If this form has previously been submitted for a patient, please retain the previous information in the “Reason for Delay” & “What arrangements are being made to facilitate discharge” and update for the current quarter No secondary code - cases that partnerships are unable to, for reasons beyond their control, secure a patient’s safe, timely and appropriate discharge from hospital. 24DX, 24EX, or 42X - patients awaiting place/bed availability in a specialist facility where no appropriate facility exists within the NHS Board area. 71X - patients exercising statutory right of choice - where an interim placement is not possible or reasonable. From July 2010 Census, Adults with Incapacity Act delays over 6 months (secondary code of 51X) should be included on this form.

Questions & Discussion