DISCHARGE

TO

ASSESS

Allison Nellies

OT Manager, Victoria Hospital, Kirkcaldy

March 2016

Discharge to Assess – What’s it All About?

Discharge to

assess is based

on the principle

that most frail

older peoples’

ongoing health

and care needs

are best assessed

in their home

environment.

The model of discharge to assess for frail older

people was referenced as “Best Practice” in the NHS

England Guide for commissioners (March 2014) and

by Philp (HSJ 2012). The model has been most

widely implemented in Sheffield Teaching Hospitals

Foundation Trust with a further publication “Good

Practice Case Study: improved flow through faster

discharge” in the HSJ November 2014. There are

many other examples of D2A across England.

The Fife model, a test

of change following

redesign of the front

door therapy service

differs from other

models in that it

supports “Meeting the

needs of Frailty:

Screening and

Assessment at the

Front Door of NHS

Fife” rather than the

back door which is the

focus of many other

programmes. It is

very much a

partnership project

between the Acute

Services Division and

the ICASS teams.

Discharge to Assess Pathway Frailty Assessment

AU1/A&E

Need for Further assessment

within home environment

identified and if provided would

facilitate safe discharge

Telephone call to Discharge to

Assess OT

Scan assessment to SPOA

OT assessment – self care,

kitchen tasks, transfers and

equipment, mobility, falls and

environmental assessments

Referral on to HCSW, PT, Home

Care etc OT continues to completion

What Are the Benefits?

Assessment is “context specific” with the patient’s

needs being more appropriately evaluated within

their home environment.

Being context specific leads to a safer discharge

for patients, preventing unnecessary readmission.

The model facilitates a more rapid assessment of

frail elderly patients at the front door, improving

flow through AU1 and the emergency department.

Timelines

Autumn 2015

OT started 06/10/15

Moved to KLM ICASS 02/11/15

OT started West Fife 06/01/16

OT started GNEF February

2016

Paper submitted to unscheduled care board with non recurring costs

approved until the end of March 2016

1 WTE band 7 OT from redesign

1 WTE band 6 OT – shared between 2 ICASS teams

2.68 band 3 – across all 3 teams

Geographical Area Existing Staff Additional Requirements

GNEF 0.5 WTE band 6, 1 x 0.67 WTE (25 hours) band 3

HCSW’s

KLM 1 WTE band 7 (from

acute redesign)

2 x 0.67 WTE (25 hours) band 3 HCSW’s

DWF 0.5 WTE band 6, 1 x 0.67 WTE (25 hours) band 3

HCSW’s

Total Requirements 1.0 WTE band 6, 2.68 WTE HCSW band 3

Emerging Outcomes

Activity

0

50

100

150

200

250

300

Direct contact Indirect contacts Travel time

Nu

mb

er

of

15 m

inu

te u

nit

s

OT Timed Unit use 78 Visits (60 Patients)

0 5

10 15 20 25 30

Nu

mb

er

of

Pati

en

ts

Town

Location of Patients

Outcomes continued

32%

68%

Patient Gender n=60

GENDER M GENDER F

58% 42%

Home Circumstances n=60

LIVES ALONE

DOES NOT LIVE ALONE

47% 53%

Source of referral N=60

Referral location A & E

Referral location AU1 18%

70%

9%

3% Package of Care

n=60

Yes No Avenue Unknown

Evaluation

13%

85%

2%

Dementia Diagnosis n=60

Yes No Unknown

• Use of care measure patient feedback tool.

• Use of IoRN – to identify level of need – pre and post

intervention.

Cost

• Approximately £596 per patient.

Final Thoughts

Short-term care/daily support

HCSW – additional resource

Avenue

USCB request

TOC at back door from MoE wards