BACKGROUND
On 20th March a COVID 19 out of hospital (OOH) patient flow project was approved by the Chief Executive of UHMBFT to direct the system response needed to support the imminent healthcare issues for the Elderly and Frail in Morecambe Bay arising from the current COVID 19 pandemic. Rapid progress has been made which we can now share with you.
The key objective of our work is to design the optimal patient flow out of hospital during the COVID 19 pandemic and protect our acute bed capacity for those who need them, supporting all healthcare providers working within the community setting with unambiguous triage and referral protocols. All of this is supported by information sharing across the health economy so we can make the right choices for our patients based on their expressed wishes and needs. Whilst our primary focus is keeping patients out of hospital where this is not in their best interests, equally we need to make sure the hospital discharge process is optimised and again community services social care and 3rd sector support will be key to making this as good as it can be in the current pandemic.
The clear concern is that during the pandemic the peak of admission admissions are forecast to exceed the planned acute bed capacity in both best and worst case scenarios.
Our progress to date:
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The creation of anticipatory care plans (ACPs) for the frail and elderly who do not have one currently to support admission avoidance to respect the needs and wishes of the patient was the first big focus. Primary and community services have worked hard to fill the gap and in six days there are now 300 more anticipatory care plans in place
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A call handling service has been established using the team at Cumbria On Call service to capture initial patient details and condition for the COVID 19 OOH triage team
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A virtual COVID 19 OOH clinical triage team is being recruited now (closing date of Monday 30th March at 12 Noon) https://www.jobs.nhs.uk/xi/vac.... This team from 1st April will co-ordinate the best options for patients, whether this is to stay in the home setting with support or be admitted to hospital
• A virtual referral support team is being recruited now (closing date of Monday 30th March at 12 Noon) https://www.jobs.nhs.uk/xi/vac... to support patients at home with the care they need. This team from 1st April will refer patients to a reduced number of community services and, when established, new primary care ‘Red hubs’
The revised patient flow will adhere to the following design principles:
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We will keep our vulnerable or frail citizens in a home care setting, or as near to home as possible
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We will use existing clinical support tools - information sharing, care planning, referral protocols – to best effect to support admission avoidance and rapid discharge
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We create a system response to a system wide issue
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We will design, digitise, deploy and train best practice clinical pathways to ensure effective
triage sieve and sort. We are creating a clinical reference group to quality assure what we
deploy
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We will mobilise where possible and appropriate wider community resources to assist in
delivering a system response
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We will empower our frail and vulnerable citizens to articulate their wishes on their care
NEXT STEPS
The intention is that by 1st April 2020 we will:
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Continue to encourage primary care colleagues to accelerate the completion of COVID-19 ACPs
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Implement the command functions of call handling, clinical triage and referral support to both support admission avoidance but also rapid discharge into the community
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Continue to support and refine our approach within the wider system response being co- ordinated by Gold Command