Sheffield DTOC: Embedding the Mindset of “Why not home? Why not today?”

In Sheffield we believe that when you need hospital treatment there is no better place to be than hospital.

Once hospital treatments are completed, getting you back home quickly is important to help you recover.

Our vision is to create a system for patients and staff that is simple to use and quick to respond, so that the help and support required to get you home will be available when and where it is needed. A system that works together to give you the best possible chance of recovery.

Where were we when we started? When we began Sheffield had a significant DToC problem. In the winter prior to the programme we averaged 4,500 DToC each month and didn’t have in place the mindset or evidence-based decision making processes to help us improve. Feedback on the mindset across the system described a lack of trust and “siege mentality”, no common goal and evidence base, and care not centred enough around the patient.

Making the Change The need to improve was clear, so we developed a programme to support a real change in how we approached DToC.

This programme was built on the following principles:

1. That people come to hospital to receive acute medical treatment. When that treatment is over, we aim to get them out as quickly as possible.

2. We want people to be as independent as possible and always aim to get people home.

3. Assessments regarding long-term care are not made from hospital.

The programme consisted of 3 workstreams each focusing on a different area:

1. In Hospital – aimed to ensure patients are ready to go on the day they become medically fit for discharge with a focus to get people back home to their usual place of residence.

2. Assessment at Home – the goal was to create a service that feels seamless to people and supports people at home as soon as they are no longer benefitting from acute care, utilising the discharge to assess approach. A large portion of this work focused on “Hiding the wiring” to make discharges simpler for the wards.

3. Assessment Somewhere Else – the best decisions around long-term care are not made from an acute setting. This workstream developed the appropriate capacity and use of off-site beds to support both rehabilitation and assessments in the community and ensure that we meet KPI’s such as 3.5% DToC and less than 15% of CHC assessments in hospital.

Wrapping around these 3 workstreams was a newly designed data and operational process which, supported by a step change in the quality, availability and simplicity of live information, enabled real, evidence-based decision making.

Results As of a result of this programme and the hard work and commitment from everyone involved, Sheffield successfully reduced DTOC to its lowest level in years, started to improve the mindset and behaviours of the system and foster a truly patient first approach.