1. Delayed Transfers of Care Nursing Home Beds Review Claire Walker Divisional Manager – Integrated Clinical Services

2. Background High DTOCs summer 2013 20 to 37 individuals - 128 to 208 bed days PW UCB agreed additional community bed capacity needed in Brent and Harrow NH beds to relieve Acute pressures Target of max 10 DTOCs across 2 sites. Beds available from August 2013 to 31st March 2014.

3. Project Details Band 7 Acute Nurse/discharge coordinator Managing a team of three occupational therapists. Agreeing costs securing beds - 11 care homes and 1 B&B. Assessment of patients suitability for transfer inc. medically stable Matching patients’ individual needs with the skills and expertise of specific care homes. Visiting and Liaising with care home staff Daily MDT at the Trust and discharge planning Managing issues from patients, families and care homes Record keeping, managing invoicing and payments.

4. Team Role Discharge planning Comprehensive patient assessments Daily maintenance rehabilitation Referrals to social services and rehabilitation units. Assessment of inpatients for DTOC beds. Management of patient caseload. Daily MDT meeting to discuss patient care and further planning. Managing minor issues/complaints from patients.

5. Whole System Efficiencies 106 admissions 90 discharges by 31 March Bed days used in NH: ResponsibleAugSepOctNovDecJanFebMarTotal CCG381622413423753494354792421 NWLH01002522773173152332911785 Total382624936196926646687704206 Average daily patient occupancy in care homes -8.7315.920.6322.3221.4223.8624.84

6. Cost Benefit Estimated cost efficiencies: NH project costs vs average acute bed day cost. This is a very crude measure. Acute hospital bed cost Team Costs Nursing Home bed cost (Average) Cost efficiency gained £1,261,800.00£80,742.00£378,540.00£802,518

7. Length of Stay LOS for 90 discharged patients was 34.87 days LOS if we discount the patients with complex pressure ulcers, housing issues and NWB patients was 29.9 days. NWB patients: 27 with LOS 49.85 days.

8. Discharge Destination and Readmissions Discharge Destinations: Readmissions to hospital HomeHospitalHousingPlacementRehabRIPTotal 37127267190 41.1%13.3%7.7%28.8%7.7%1.1% Bowel Obstruction Fractured NOF Haematuria Infection – UTI/Chest High Blood sugars Total 1127112

9. Quality No major quality issues raised Patients discharged once stable for agreed destination Complex rehab was not provided or intended NWB post plaster removal received OPD or community rehab once home No comparison done between NH beds Visiting staff progressed discharge issues