Nottingham CityCare Chief Executive Lou Bainbridge sees first-hand how our Front Door Integrated Discharge Team is helping to get medically fit patients out of hospital safely and effectively.
When we think of the NHS we often think about busy hospitals and staff under pressure. Headlines are dominated by A&E stories and a system struggling to cope with pressure and demand.
Teams across Nottingham CityCare are working hard every day in the community as part of the wider health and social care system to ensure patients are staying safe in their own homes and preventing hospital admissions. We also play a key role in preventing re-admission to hospital. This is community health care – a growth area as outlined in the NHS Five-Year Plan.
As Nottingham’s largest provider of NHS community health services, we deliver care for city patients in their homes, GP practices, heath centres and schools. What some might not know is our community staff are also located at the “front door” of Nottingham University Hospitals’ Queen’s Medical Centre (QMC), which has one of the busiest A&E departments in the country.
Our 14-strong Front Door Integrated Discharge Team works with hospital and social care teams to safely discharge medically fit adult patients to the community.
It was great to meet the team and see their work at first hand. Team Manager Ann James and Amy Morris talked me through the service, referrals process from the hospital front door (that is, the emergency department, fracture clinic and urgent treatment unit to name a few).
The service assesses patients referred to them by hospital staff, who may need additional support at home (Pathway 1,) a period in a bed in the community (Pathway 2,) or those who have enhanced needs and/or additional assessment with longer-term needs (Pathway 3.)
The team undertakes comprehensive assessments of adult patients who require a supported discharge from the hospital, intending to prevent unnecessary admissions.
Patients are reviewed irrespective of where they live. Therefore, the team has a vast knowledge of pathway options and services that support discharges for Nottingham, Nottinghamshire, and beyond.
Assessments are carried out in conjunction with individual patients (and their carers/relatives where appropriate) in line with their needs and wishes in the Emergency Department and Assessment Ward of the Queens Medical Centre hospital. Patients are assessed by the team’s physiotherapists, occupational therapists or assistant practitioners providing equipment if needed such as walking frames to hospital beds.
The speed at which the team are able to discharge patients safely with either a social care package or equipment enabling the patient to remain independent and safe within the home is amazing.
Here are some impressive statistics that demonstrate their performance:
- Emergency Department (ED) assessments:
- The team has consistently met, or exceeded, the threshold of 95% for completing initial assessments within 2 hours from referral.
- In February, March and May 2024 the team completed 100% of all initial assessments in the ED within 2 hours.
- April 2024 saw the highest number of initial assessments in the ED, with 56 assessments, 96% of which were completed within 2 hours.
- Same-Day Emergency Care (SDEC) assessments:
The team maintained a ‘perfect’ record for initial assessments in SDEC, with 100% of assessments completed within 2 hours from referral in December 2023, April 2024, and May 2024.
- Assessment Ward assessments:
- December 2023: 95% of 83 assessments completed within 8 hours.
- January 2024: 97% of 78 assessments completed within 8 hours.
- April 2024: 99% of 75 assessments completed within 8 hours.
Seeing the difference the team is making for patients, the integrated way in which they work and their passion was heartwarming and made me feel so proud!
The team is located in the heart of the QMC which enables them to build strong relationships with health and social care system partners to deliver a seamless service to our patients.
They play an integral role in taking the pressure off staff at Nottingham University Hospitals (NUH) by helping to avoid patient admission and allowing hospital beds to be used for those most in need of acute hospital care.
This is a fine example of how Nottingham CityCare is helping our local busy hospital work more effectively and efficiently, ensuring patients flow into the community in a co-ordinated and safe way.
I’d like to thank the whole Front Door Integrated Discharge Team, and colleagues from NUH and social care who spent time talking me through their valuable roles and for the difference they are making every day.
Lou Bainbridge
Chief Executive
Nottingham CityCare Community Interest Company (CIC) Partnership
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Date published: 6 June 2024