Catalogue of change

Case study: Nessa Greenwood, South Tyneside and Sunderland NHS Foundation Trust (STSFT)

Background to learning:

The pandemic has led to the NHS making changes to the way it delivers a number of services to patients. This has been to enable people to receive the care they need in an environment that meets their requirements, while reducing the risk of spreading of COVID-19.

At STSFT it was recognised there was a need to adapt discharge planning processes to help avoid delays for patients leaving hospital. A new model was created, establishing a new Integrated Discharge Team (IDT) and the development of a new discharge process to support safe and timely discharge of people medically fit.

Learning and advice to be shared
The IDT includes senior nurses specialised in discharge assessment, trusted assessors, social workers and discharge liaison officers to ensure a comprehensive offer to patients and ward staff. The IDT operates every day from 8:00am to 8:00pm with a named nurse coordinator supporting the discharge of patients by liaising with the relevant services, such as rehabilitation services, homeless services, district nurses and social services. Streamlined referrals to community services during the pandemic have also supported staff to avoid unnecessary delays.

The IDT also rapidly introduced a new ‘RED 2 GREEN’ Days model and integrated discharge pathway to support discharge decision-making and to make sure patients support needs are identified. This huge effort, embedded at ward level during the pandemic, also supports upcoming seasonal pressures, ensuring optimum patient flow across the hospitals, enabling improved patient experience and discharge as soon as patients are medically fit.

At the CNO National Shared Decision-Making Council, members discussed discharge planning and shared their experiences of discharge processes during the pandemic. A common theme was noted of the beneficial support that dedicated discharge teams brought to complex discharge planning.  Here, communication across disciplines both internal and external to the hospital was thought to be key in maintaining strong working relationships.

The council noted helpful colour coding of wards to identify infection control status and other approaches such as the use of traffic light systems and using digital technology to actively manage discharge processes.  The council also highlighted collaborative approaches with non-NHS sectors including local hotels to support the discharge of homeless patients – ensuring their safety and wellbeing, while care and support was put in place.

Would it be beneficial to retain these changes?
Coordinated approaches to discharge planning support organisations to provide seamless care from admission through to discharge. Utilising an MDT approach ensures services are ‘wrapped-around’ the patient, offering a safe and timely discharge which is inclusive in its decision-making approach.

The transparency of a coordinated IDT and its’ processes supports patients, carers and relatives to feel reassured that the support given is in accordance with individual patients’ needs prior to discharge and they are involved at each step. It also helps early identification of individual patients who will need additional support packages or have complex discharge circumstances.

A person’s holistic needs must be identified early when admitted to hospital, including how they will be safely discharged and during the pandemic this continues to be paramount. Through systems working effectively together, we can continue to ensure people can access the right care, in the right place and at the right time as well as support our staff across the system during the COVID-19 response. Discharge to assess models offer nursing and midwifery colleagues the means to support this for all adults across England.

For any further detail on this case study, please contact: england.1professionalvoice@nhs.net
 

Case study: Nessa Greenwood, South Tyneside and Sunderland NHS Foundation Trust (STSFT)

Background of change and intervention

Hospital visiting arrangements during the pandemic have aimed to prioritise the health, safety and wellbeing of our patients, communities and staff. Initial guidance suspended general visiting whilst continuing to support compassionate visiting when needed, for example at the end of life. More recent guidance (June 2020) provides discretion for trusts to define local visiting arrangements having considered wider social distancing policies. This case study focuses on how nursing teams have worked together with patients, families and carers to support a better experience during a required restricted visiting approach.

Learning and advice to be shared

Many nurses reported that they recognised the difficulty visiting restrictions caused patients and their loved ones and the need to support in spending more time with their patients by talking, reassuring them and continuing to deliver high quality care.  Those that usually visited were also recognised to be anxious about not being able to see their loved ones and health care professionals spent more time speaking with family and carers on the phone to inform and reassure. Additionally, the lack of visiting also identified that sometimes valuable bespoke information, or history from family members or carers, could be harder to access and opportunities for nurses to communicate (to explain to the family/carers for example simple discharge home instructions) could be constrained.

The absence of the important supporting role from family (especially for patients who had dementia, learning disability, mental health problems and, end of life care needs) was identified as a real challenge.

Also, visitors could find the situation stressful, and keen to understand how visiting limitations were being applied and the reasons why.

STSFT developed several initiatives to provide support to patients, visitors and clinical teams:

• virtual visiting using hospital iPads so patients could see and speak to their families via video calling
• supporting outgoing phone calls to families through the bedside TV provision
• encouraging the use of the trust Wi-Fi
• ‘Carers passports’ developed to enable an identified family member to visit, in line with social distancing, to support appropriately identified patients
• ‘Sending Love’ initiatives whereby people can send messages, letters, postcards or photographs to their loved ones in the hospital.

Would it be beneficial to retain these changes?

Many of these changes are enabled by technology. NHS Wi-Fi is now widely available across acute and primary care settings and offers a range of possibilities for staff and patients, including staying connected to friends and family in ways that they are used to. These have provided a vital link with home during the pandemic and are useful for the future.

Clinical staff could signpost patients to useful health apps, for example to support the psychological health and wellbeing of many inpatients. Other patients may simply want to get organised for after their discharge, for example by booking their follow up primary care appointments on the relevant app.

The NHS Long-Term Plan aims to support a delivery of person-centred care, acknowledging “the importance of ‘what matters to someone’ is not just ‘what’s the matter with someone’”. These approaches demonstrate how nursing teams working with other trust colleagues such as those expert in estates, or family liaison teams, can come together to provide this person-centred care

For any further detail on this case study or to connect with Nessa, please contact england.1professionalvoice@nhs.net