Partnership working across all levels of the organisation is vital to affect change and improve patient flow. The system leadership working together and sharing issues is an important first step, but it is the integration of frontline operational teams that has driven an understanding of each other’s cultures and pressures, and has made a tangible difference to patient flow.
Examples in North Cumbria:
- Reducing delayed transfers of care
After an initial assessment in June 2017 across the North Cumbria system, we found that there were over 43,000 bed days where patients were medically fit but awaiting discharge. This was impacting over 2000 of our citizens each year.
To address this, we first established accurate and timely recording of delays across both acute and community beds, then cross-system groups to tackle the delays at both a patient and a theme level.
On a daily basis, an MDT group with practitioners from both acute and community providers, as well as adult social care, reviewed the patients who were delayed and took action to progress them towards discharge.
On a weekly basis, a group with representation from the acute and community providers, the CCG & adult social care met to review the most prevalent causes of delay and take action to fix the underlying problems.
Across the first six months, this led to a reduction in reportable DToCs of ~40%.
- Establishing Integrated Care Communities teams in the acute
An Integrated Care Community (ICC) is made up of a team of health and social care professionals, GPs, voluntary sector organisations and wider community providers, who work as one team to support the health and wellbeing of local people. The ICC teams in Cumbria are based in the acute sites, and are able to pull patients out, and drive down the time between patients being medically fit and being able to leave hospital.
A key component of this work is a daily review of stranded and super-stranded patients, between the ICC team who link to the community, and the acute matrons & managers.