Abstract
BackgroundAgainst a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs. Improving patient outcomes requires change across hospital and community systems. Our objective was to change practice in order to deliver a Hospital at Home programme (admission avoidance and early supported discharge) for frail older people across a regional commissioning area. The programme, undertaken within the Northern, Eastern & Western Devon Clinical Commissioning Group (CCG) sub-localities of Exeter (population 120,000) and Woodbury, Exmouth and Budleigh Salterton (towns with populations of around 10,000), involved reconfiguration of existing services rather than being a stand-alone intervention.MethodsQuality Improvement methodology, with hospital and community staff using Plan-Do-Study-Act (PDSA) cycles to implement and test service changes. Outcome measures: 1) Discharge destination; 2) Length of stay; 3) Acute Community Team referrals.ResultsAgainst a backdrop of intense financial pressures, significant community bed closures, and difficult relations between hospital and community services, outcomes remained stable (discharge destination, length of hospital stay, and number of referrals to the community team).ConclusionPDSA cycles enabled stakeholders across acute and community services to be involved, promoted a process of collaborative inquiry and ownership of findings, and improved motivation to act on results and produce change. Practitioners and managers seeking to improve the delivery of complex, cross-cutting services in other areas can learn from the experience of applying Quality Improvement methods reported here.
Highlights
Against a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs
Our study focused on the question: What is the impact of using Plan-Do-Study-Act cycles to re-reconfigure and implement a Hospital at Home service for older people in the Exeter sub-locality?
The Rapid assessment at home team (RAAH) team expanded in scope and scale, developing from an admission avoidance service to an admission avoidance and early supported discharge service that worked closely with the acute hospital
Summary
Against a background of rising numbers of frail older people, there is a need to improve quality and safety of services whilst containing costs. The provision of care to older people that is proactive, preventive, person-centred and delivered nearer to the patient’s home is a priority from both a quality and cost perspective [1, 2]. Delivering this care to older people with complex co-morbidities requires integrated working. ‘Hospital at Home’ for frail older people, involving admission avoidance (typically proactive health and social care services designed to support people in the community to avoid them ‘tipping’ into needing acute hospital care) and early supported discharge, is a key way of reconfiguring complex services and working relationships in pursuit of this goal
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