How hospitals are working to get medically fit patients home

That is the message and challenge continuing to face hospital bosses.

Around 200 patients remain medically fit to be discharged from University Hospitals Dorset’s Royal Bournemouth and Poole sites.

Chief operating officer Mark Mould said there were still too many people occupying beds when they were ready to leave hospital.

“While we have made progress and we have made progress, ultimately, we want to have everybody who doesn’t need an acute hospital bed receiving the care in the right location,” he told the Daily Echo.

Mr Mould added: “We want the beds to be available for the people who really, really, really need our beds for the acute care.

Mark Mould

“We really care about those other groups of patients but actually they can receive their care and ongoing support at home or in beds outside our hospital.

“We are working across the system to put that in place but we have a distance to go.”

Families can play their part in supporting the move out of hospital, however, Mr Mould acknowledged this can be difficult.

He said: “We have got 1,100 beds in the hospitals. We have got around 750,000 beds in people’s own homes in Dorset.

"It is about how we mobilise capacity through the support of domiciliary care to support people in their own home.”

Earlier this year, the trust was visited by national discharge team officials from NHS England and the Department of Health and Social Care.

Donna Parker, who is supporting UHD’s discharge agenda, said there was a national challenge around patients who really needed to get out of hospital when the acute care they needed had been completed.

She said the situation was particularly challenging in Dorset given a high proportion of the county's population is aged over 80.

Discussing the national discharge team visit, Ms Parker said: “We were keen for them to come and see and bring some fresh eyes to the system.

“This is the expert national team. Can you bring some fresh eyes to us, is there any more we can be doing, what is happening elsewhere and can you bring any of that expertise to us?”

She added: “One of the key things they picked up on was our frailty and our planning for those pathways.

“They were very keen to see the system work that had progressed in Dorset but also how we continue to build on that working as partners across all of the health and social care organisations.”

The visit highlighted the work of the discharge to assess programme, which focuses on how patients can leave hospital for care assessments rather than remain in hospital.

Trust chiefs say this will have a significant impact on the number of medically fit patients in hospital beds.

“The principle is that once patients have completed their acute episode, we have done the optimum that we can with them in the hospital with the resources and the skills we have got here, patients really would then be best being in other places,” Ms Parker said.

“That might be their own home, it might be a care home kind of setting, it might be a community hospital setting, but overall a setting where their recovery, their rehabilitation and, or, the assessment of their ongoing needs can happen in a better place than a very busy acute hospital ward.”

Another area of recent progress is the increased use of discharge lounges – a four-fold rise in the past six to eight weeks.

The lounges help with patient flow as people who are ready to leave hospital have arrangements made while freeing up beds.

Mr Mould said: “It basically means people who need to access the bed that the person is in can do so earlier.

“Secondly the discharge lounge can take responsibility for getting people ready to leave the organisation, making sure medications are in place before they leave and arranging for the transport to be booked in a nice comfortable surrounding.”

Mr Mould said there remained concerns and an acceptance that ambulance handovers at the front door needed to improve.

“We are looking at every single small action that can improve the flow through the organisation,” he added.

“A real focus of the people in the discharge lounge is to look after our patients before they go home. It allows us to reduce ambulance handovers, decompress our emergency department and pull people through the organisation and get people in the right beds at the right time.”