The transition period from preparing to leave the hospital (being discharged) to the first few weeks at home can be risky, particularly for older patients.
Most research on hospital discharge has looked at when things turn out badly: a patient has to go back to hospital or has their safety compromised. The authors of this study wanted instead to look at best practice. How do high-performing general practice and hospital teams ensure older patients are safely supported during the transition from hospital to home?
Multidisciplinary staff from general practice, hospital and community care teams were interviewed about what they felt was important for a successful transition. The study identified three factors: knowing the patient; knowing staff within and across teams; and bridging gaps in the healthcare system. These factors were challenging to achieve and were typically only in place when supporting the most complex transitions.
The findings suggest it is valuable for healthcare teams to take time to get to know their older patients and collaborate with other professionals responsible for their care. Structural and systemic changes may also improve safety at transitions.
The purpose of this guidance is to support RCSLT members to make informed decisions about safe ways of working during the COVID-19 pandemic. The RCSLT recognises that as we learn more about the virus, local and national advice may change.
Ward rounds are the focal point for a hospital’s multidisciplinary teams to undertake assessments and care planning with their patients. Coordination of assessments, plans and communication is essential for effective and efficient care.
In acute settings, active treatment is often the default course of action, such that busy teams may find it difficult to pause and recognise that someone is dying until that person reaches their final hours or days. This resource supports physicians to identify patients in the acute setting who are dying, to start EOL conversations with patients, families and carers, and to recognise that every patient will have different priorities in how their EOL care is managed.
This guidance refers to and should be used in conjunction with the RCP report Talking about dying.
Background Pregnancy has been defined as a risk factor for COVID-19, and pregnant women are therefore considered to be more vulnerable than the general population. Maternity services have experienced staffing shortages of up to 20% during the COVID-19 pandemic, which for many units is more than double their previous shortages. Maternity teams also have staff who are required to work from home while shielding resulting in some maternity services being unable to provide maternity care in the traditional way. As localised risk assessments allow for the lifting and revision of the initial high-level restrictions applied across the UK by Governments and within healthcare, it is vital that each maternity service applies a safe and appropriate revision of their restrictions and processes. We also know that this progress does not just move in one direction. While restrictions were able to ease in many areas of society over the summer of 2020, when the prevalence of the virus was low, the Autumn of 2020 has seen a significant increase in cases. The start of 2021 has led to a further national lockdown and the reintroduction of increased visiting restrictions. Changes to visiting restrictions or access of partners and support people in maternity care requires consultation with staff and with women’s service user representatives to develop a coproduced risk assessment and policy revision process.
Organisation: HealthWatch West Sussex & The Disabilities Trust Published date: December 2020
Rachel Priestly, Service Manager, The Disabilities Trust and Cheryl Berry, Healthwatch West Sussex worked in partnership to develop the Best Interest Discussion Making Toolkit.
This followed discussions and a shared concern that health and care professionals were not structuring their conversations with individuals who lacked capacity in some decision-making, leading to poor health and wellbeing outcomes. The lack of recording of discussions also meant that others failed to understand what would enable better outcomes and so poor treatment approaches were evident.
The aim of the project was to support healthcare professionals: health, social care, and community – who work with people who have cognitive impairment and where capacity fluctuates.
The Toolkit is used to structure, record, and evidence how a healthcare professional has worked in the best interest of a person and provides a paper trail. Currently there is no uniform guidance/process used. The toolkit demonstrates how to implement in practice, recommendations from NICE guidance NG108: Decision making and mental capacity.
The toolkit and associated materials can be accessed on Healthwatch West Sussex’s website here.
Organisation: Cambridge University Hospitals NHS Foundation Trust Published date: January 2021
Cambridge University Hospitals NHS Foundation Trust have increased capacity to insert implantable cardiac monitors to detect atrial fibrillation after cryptogenic ischaemic stroke by using the joint stroke / cardiology multidisciplinary team, which is working to identify suitable patients.
The practice described in this example is in line with the NICE diagnostics guidance 41 (DG41) on Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke.
Authors: Dr Kayvan Khadjooi, Consultant in Stroke Medicine, Dr Anna Chousou, Clinical Research Fellow in Cardiology, Dr V Vassiliou, Honorary Consultant in Cardiology, Dr Peter Pugh, Consultant in Cardiology.
Organisation: Sussex Partnership NHS Foundation Trust Published date: January 2021
This example describes a project to improve upon the quality of interventions for people presenting following an episode of self-harm/distress and reduce the risk of further self-harm across Sussex by:
Providing a compassionate timely and effective brief follow-up response to adults and older adults who present at A&E where self-harm and suicide attempts are recorded and captured on the A&E dataset.
Supporting connections already made via A&E referrals and signposting according to the support plan agreed following psychosocial assessment.
Evidence from the National Confidential Inquiry into Suicide and Safety in Mental Health (2018) highlights that most post-discharge deaths by suicide occurred in the first week after leaving inpatient care, with the highest frequency on the third day after discharge. Many of these people had died by suicide before their first follow-up appointment.
The NICE quality standard for self-harm in 2013 states:
People are treated with compassion, respect and dignity
They receive an initial assessment of physical health, mental state, social circumstances and risk of suicide.
They receive a comprehensive psychosocial assessment
They receive the monitoring they need to keep them safe
They are cared for in a safe physical environment
Collaborative risk management plan is in place.
They have access to psychological interventions.
There is a transition plan when moving between services.
Based on this new standard this A&E Follow-up Service would aim to follow-up with people post self-harm incidents following the principle that they are likely to remain vulnerable during this period of time and to ensure that the agreed plan on leaving A&E has been followed through. For those without a plan, it will provide another opportunity to engage and support them.
We have an ambition for a pan-Sussex service. This pilot phase commenced across three hospitals in Sussex: Eastbourne District General Hospital, the Royal Sussex County Hospital in Brighton and the Western Sussex Hospital in Worthing.
The proposal is based on current demand across the A&E departments. However, with the current COVID-19 situation as of this time in January 2021, demand is likely to increase. The pilot will help us to establish the demand for the service and the capacity needed to provide a flexible and responsive service.
The objective is consistent with the Trust’s view that the suicide of those in our care should be seen as preventable at some point in that person’s mental health journey. The project will contribute to the Trust’s Towards Zero Suicide Strategy.
The example draws upon recommendations from NICE guidance for self-harm (CG16) and the NICE Quality Standard for self-harm (QS34).
Organisation: Healthy London Partnership, part of North East London CSU Published date: February 2021
Many sets of guidance and gold-standard policies on children and young people’s (CYP) asthma are available, but we identified an opportunity for a London-specific set of whole-system standards to improve outcomes. Development of the standards involved identifying existing standards and guidelines and bringing them together into one accessible, peer-reviewed resource.
These include NICE guidelines and quality standards for asthma, as well as a number of other NICE recommendations on smoking cessation, transition, patient experience, food allergy, and medicines adherence/optimisation. The London standards cover the entire asthma pathway, and relate to all organisations involved in the care, management and support of CYP with asthma. They were originally compiled in 2016.
Developments in local and national policy and practices and the release of new standards and guidelines has meant that the standards needed to be revised and adapted. The new standards were launched during the #AskAboutAsthma campaign in September 2020.
Shared Learning 