1. Discharge from Hospital preventing ‘people stranded in the wrong place’
* Key Enablers for QIPP: 12 beds in Elderly Medicine will need to be closed by the end of November to allow surgery to recharge medicine for 12 bed Zoned area.

2. Beds aren’t capacity ‘Beds are where patients wait for the next thing to happen’ Everyone has a bed at home

3. A compelling story about our patients
We have a high numbers of outliers hospitals – associated with patient risk
A crowded emergency departments – associated with patient risk
High and sustained levels of escalation across the system
High levels of acute hospital bed occupancy
Patient experience, quality and safety – patients defaulting to the acute trust / ED

4. More about the compelling story
48% of people over 85 die within one year of hospital admission
Imminence of death among hospital inpatients: Prevalent cohort study
David Clark, Matthew Armstrong, Ananda Allan, Fiona Graham, Andrew Carnon and Christopher Isles, published online 17 March 2014 Palliat Med
10 days in a hospital bed (acute or community) leads to the equivalent of 10 years ageing in the muscles of people over 80
Gill et al (2004). studied the association between bed rest and functional decline over 18 months. They found a relationship between the amount of time spent in bed rest and the magnitude of functional decline in instrumental activities of daily living, mobility, physical activity, and social activity.
Kortebein P, Symons TB, Ferrando A, et al. Functional impact of 10 days of bed rest in healthy older adults. J Gerontol A Biol Sci Med Sci. 2008;63:1076–1081.
If you had 1000 days left to live how many would you chose to spend in hospital?

5. Dr Richard Genever - Chesterfield Royal Hospital NHS Foundation Trust
Hospital is not a place of Safety for people who are medically stable
Dr Richard Genever - Chesterfield Royal Hospital NHS Foundation Trust

6. Safe to discharge
Clinical (Medical) decision made that patient no longer needs acute care AND
An MDT decision that patient is ready for transfer AND
The patient safe to discharge
If they are awaiting assessment from external partner later then the minimum interval they are a delay.

7. Supported Discharge Identifying the care needs of the patient
Identifying the supported care pathway
Identifying the appropriate funding source
Assessment
Agreement
Placement/Care package/Reablement/Rehabilitaion
Continuing Health Care or Fast Track

8. Consent
It should be made explicit to the individual whether their consent is being sought for a specific aspect of the eligibility consideration process (e.g. completion of the Checklist) or for the full process, and for personal information to be shared between different organisations involved in their care. It should also be noted that individuals may withdraw their consent at any time in the process.

9. Majority of patients were admitted from home

10. Percentage of patients impacted by external reasons affecting their Discharge

11. What we have done to improve our discharge pathways
Reviewed and improved our Continuing Health Care pathway
Reviewed and improved our monitoring of patients with a longer length of stay
Reviewed and improved our monitoring of patients with a shorter length of stay
Reviewed and improved our communication with patients about their discharge

15. E-mail; alisonsmith11@nhs.net
Contact details for Alison Smith Deputy Chief Operating Officer Croydon Health Services NHS Trust Croydon University Hospital ;