Reducing delayed transfers of care with technology-enabled services

Joanne Denny, telehealth triage nurse at Tameside and Glossop NHS Foundation Trust, discusses the deepening problem of delayed discharge within NHS hospitals and how telehealthcare can be used as an enabler for timely discharge

In this article, Joanne Denny, telehealth triage nurse at Tameside and Glossop NHS Foundation Trust, discusses the problem of delayed discharge within NHS hospitals and how telehealthcare can be used to allow for timely discharge

Delayed transfers of care are one of the most-significant issues facing the UK’s health and care ecosystem, and are consistently one of the top three concerns expressed by NHS finance directors.

Delayed transfers of care are one of the top three concerns expressed by NHS finance directors

A recent independent report commissioned by the Department of Health has revealed that approximately 8,500 patients who are medically fit to leave remain in NHS hospitals every day, costing the health service £900m a year.

As well as causing immense financial strain, these delayed transfers of care (DTOC) affect the flow of patients through the hospital, resulting in a knock-on effect of delayed waiting times for pre-planned operations. Longer lengths of stay also increase the risk of hospital acquired infection, and can cause functional decline and reduced independence for patients.

Addressing the issue

DTOCs are in part a result of the disjointed relationship between health and social care, with almost half of all delays due to an absence of suitable care support packages to facilitate patients’ aftercare.

The reduction in adult social care funding – down 17% in real terms since 2009 ¬– coupled with an ageing population and a declining number of hospital beds has created a growing problem.

Addenbrooke’s Hospital in Cambridge, one of the largest hospitals in the UK, illustrated the plight of patients confined to hospital beds, despite being fit to go home.

In an article for The Guardian in 2015 it was revealed that 87 of its 1,000 beds are occupied by frail, older individuals classed as DTOC patients. Almost a quarter of these patients had been ready for discharge for at least three weeks. The hospital was forced to declare a major incident, rationing less urgent care to cope with demand.

This situation is reflected in hospitals across the UK. Having been deemed fit enough for discharge, patients want to return home and doctors want to let them go. But, unless there is a guarantee that some form of care package will be provided, they are duty-bound to keep individuals within the hospital setting. While this is incredibly distressing, and possibly detrimental, for patients, it also has serious implications for the hospital.

An accelerant for discharge

So what is the solution? How can we engineer our healthcare services to provide timely interventions that promote self-care, improve clinical outcomes, and reduce costs?

With resources stretched to breaking point, technology has a significant role to play in enabling providers to manage demand effectively

For some health and care providers, the key to gaining control over the spiralling problem of delayed discharge lies in the active integration of telehealthcare technology into care pathways.

Leading by example

Supporting patients in the community can help to get patients out of hospital earlier, prevent them being re-admitted, and enable early intervention to avoid the need for more-complex care in the future.

With resources stretched to breaking point, technology has a significant role to play in enabling providers to manage demand effectively.

A pioneer of this approach is Tameside and Glossop NHS Foundation Trust, which serves a population of almost 250,000 and has a high prevalence of people with long-term conditions living in the area.

In 2009-2010, heart failure and Chronic Obstructive Pulmonary Disease (COPD) resulted in 1,024 emergency hospital admissions for Tameside and Glossop. This alone equated to a cost of approximately £2.7m, which was predicted to rise to £3.5m annually over the next 10 years.

In order to address the predicted increase in demand for services, NHS Tameside and Glossop invested in telehealth to enable care pathways to be redesigned to support more patients with long-term conditions in the community, providing the trust with the tools to self manage.

Positive results

Evaluation of the service in Tameside showed that telehealth facilitated early discharge, and prevented admissions to hospital.

Data from April 2014, based on 221 telehealth patients over 12 months, showed 122 hospital admissions for these patients up to six months prior to their telehealth installation, which reduced to 75 admissions post telehealth. Of the 75 patients who were admitted post installation, 38 were not admitted in the first two years of installation. All 75 patients admitted were discharged earlier than the average bed stay for the condition, and only one patient was admitted to hospital within the first 12 months of installation.

By bringing care ‘closer to home’, hospital bed days can be reduced, thus helping to free up much-needed resources, and ensure that A&E departments and hospital wards are better placed to care for those in need of medical attention

The service also resulted in a reduction in the frequency of some home visits by the Long Term Conditions Management Team (LTCMT), and a reduced number of inappropriate visits, supporting effective caseload management. By identifying changes to vital signs and symptoms, the service has also enabled earlier intervention, helping to avoid the need for more complex care.

An opportunity for change

As demonstrated by organisations such as Tameside and Glossop NHS Foundation Trust, the implementation of telehealthcare can go some way towards reducing the strain on our care systems.

By bringing care ‘closer to home’, hospital bed days can be reduced, thus helping to free up much-needed resources, and ensure that A&E departments and hospital wards are better placed to care for those in need of medical attention.

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