Winner

The Rotherham Foundation Trust: Working together across health and social care for effective discharge management

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The Rotherham FT worked with its local council to tackle high delayed discharge rates and ensure home was the default option for suitable patients leaving hospital. Previously, the trust had had delayed discharges rates of over 8 per cent and many patients suitable for discharge to home were not getting there immediately.

An integrated discharge team and a simple electronic referral process were a key part of the change, together with co-ordinated support for discharge home to ensure that patients had the right level of support.  

A therapy “trusted assessor” helps admission avoidance in accident and emergency and the acute medical unit. Delayed discharges are now mainly below 3.5 per cent and more patients are being discharged home – more than 80 per cent of over 65 non-elective admissions are now going straight home.

Patients are generally seen by the integrated discharge team on the same day and discharges are better planned.

Read a detailed case study about this project at HSJ Solutions

Finalists

  • Betsi Cadwaladr University Health Board: Improvements since thromboprophylaxis walk around – HIGHLY COMMENDED
  • Midlands Partnership FT and University Hospitals of North Midlands Trust: High Intensity Users Service
  • Salford Royal FT: Salford Polycystic Kidney Disease Multidisciplinary Clinic
  • Tameside and Glossop Integrated Care FT: Electronic Advice and Guidance
  • The Ambulatory Emergency Care Network (NHS Elect): Supporting the NHS to redesign emergency care to provide ambulatory emergency care and reduce reliance on hospital beds
  • The Princess Alexandra Hospital Trust: Abdominal Pain Pathway
  • University College London Hospitals FT: Ambulatory care for complex cancer treatment and stem cell transplantation
  • University Hospital of North Midlands Trust: North Midlands Pleural Unit
  • Wirral Clinical Commissioning Group: Musculoskeletal Integrated Service