East Lothian Discharge to Assess service features in this month’s Frontline magazine

The Chartered Society of Physiotherapy’s Frontline magazine this month features a leading article on our Discharge to Assess service read full article below

A three-year project to embed discharge to assess (D2A) as a core East Lothian service

Jo Pilarksa, advanced physiotherapy practitioner, shares her highlights of a three-year project to embed discharge to assess (D2A) as a core East Lothian service

The Innovations in Physiotherapy database is an online platform of quality assured examples that showcase innovation.

Purpose

  • To promote a change in culture from the ‘assess to discharge’ model of care
  • To facilitate timely and effective discharge of patients who are clinically fit and appropriate to have their therapy assessment at home
  • To develop a culture of ownership of East Lothian patients throughout their patient journey

As of April 2020:£1,048,500 estimated cost saving (cost calculated at £300 a day)

Methods

D2A referral criteria and pathway was established in 2015 in consultation with NHS Lothian acute sites and East Lothian Council. D2A enables: 

  • Comprehensive same day or next day physiotherapy/occupational therapy assessment 
  • Ongoing person-centred care delivered in a patient’s own environment, including provision of equipment, minor adaptations and short term therapy support
  • Education and awareness sessions delivered to referring staff
  • Standardised recording and audit processes
  • Collaborative working with East Lothian discharge co-ordinators and community teams  
  • Daily screening of admissions lists from acute hospitals to proactively ‘pull’ patients from hospital
  • Weekly in-reach by the D2A team to orthopaedics, stoke and medicine of the elderly at the Edinburgh Royal Infirmary.

Implications

  • D2A is now fully embedded within the wider East Lothian community services and is a key alternative discharge pathway
  • D2A fulfils NHS Scotland’s strategic aims, of returning patient to their own homes as soon as appropriate, with minimal risk of re-admission.

Next steps

  • Development of a seven day working initiative to support weekend discharges
  • Extend site coverage and capacity of D2A in-reach
  • Creation of a locality based health and council rehabilitation team supporting discharges and prevention of admissions. 

Top three learning points

Developing a culture of ‘ownership’ of our East Lothian patients has enabled us to support patient flow and effect positive change on discharges.

Enhancing communication links between clinicians and services across community and acute sites has been crucial in building relationships and trust.

Developing a shared vision was a key part of our success. 

Integrated HSC Clusters and TEC play key roles in improving the patient experience

By Ali Buchanan

Our Discharge to Assess (D2A) service has been facilitating flow across all sites. Through the development of Integrated Health and Social Care Clusters, our Occupational Therapists and Physiotherapists facilitated 51 discharges in April. Each of these reflects a saving in bed days and reduced length of stay for inpatients who are medically ready to return home. Same day assessment for those referred by GPs to prevent admission to hospital has also been key in reducing pressure on the acute at this time.

We are using technology enhanced care (TEC) in new and innovative ways to support our rehabilitation. One way of doing this has been enabling patients to communicate with loved ones while in hospital with Kindles and iPads, improving their psychological and emotional recovery. These devices have also contributed to discharge planning when families can show therapists the layout of a person’s home, enabling their clinical decision making in facilitating patients home.

New ways of working for COVID-19 and beyond

MSK Physiotherapists are currently trialling the use of iPads to enable us to help those unable to access normal physiotherapy services during COVID-19. This allows people struggling with an MSK complaint access to the information they need to manage their condition by being supported in use of apps relevant to them. We fully expect this practice to continue post-COVID and be rolled out to the drop-in clinics.

Latest RNIB Podcast

With some really useful tips and thinking around older people with sight loss from Marion MacMillan, RNIB UK Learning and Development Officer

I hope this finds you well, and coping with the strange circumstances in which we are currently living/working. 

I’m writing to let you know that the latest podcast from the RNIB Older People and Complex Needs Team is now live here: https://www.rnib.org.uk/health-social-and-education-professionals/social-care-professionals/working-older-people/supporting-older-people-podcasts

In this podcast Iain and June chat about useful tips when talking to an adult with sight loss. There’s even a mythbuster in there!  Please could you share with any colleagues you think might be interested in listening.

As always, we welcome any/all feedback you can give us – just reply to this email, and tell us what you liked, what you didn’t like, and anything else you’d like to say.

We have an Open Badge linked to the podcasts, which you can apply for if you have listened to any of them.  Please could you pass this on to colleagues too.  Here is the link to the Open Badge: https://www.badges.sssc.uk.com/badges/rnib-podcast-older-people-and-complex-needs-series/

Please don’t hesitate to get in touch with any questions.

Kind regards

Marion

Marion MacMillan
UK Learning and Development Officer
Older People and Complex NeedsTeam 
RNIB 
T: 0141 648 8507
Int: 522 8507
Mobile: 07548 138 875

An innovative approach – Enable and ELHSCP

Enable have been very creative with support a service user who is self-isolating due to being unwell.

The team have rallied around the service-user with home cooked meals being dropped off, Facetime quizzes twice daily and also Facetime support to ensure the flat is being kept clean and tidy/house, chores are being done and everything is as it should be (as if staff were still visiting the flat on a  daily basis). 

Our service-user appears to be managing the situation really well and has really stuck to the self-isolation guidance – he comes down once a day to collect his evening meal from the back door. 

The Team as mentioned above have been doing a lot of Facetime with him as we mentioned before and the quizzes are around the service-user’s activity of choice. A staff member played darts with him the other day (the service-user played in his home and staff played in his!) The service-users is engaging really well with this which is fantastic.

Sent in by Sarah Wall, Senior Practitioner, Adult Wellbeing