S.T.A.R.S. (Short Term Augmented Response Service) Tuesday 12th June 2007 Gail Edgar Service Manager.

S.T.A.R.S.

(Short Term Augmented Response Service)

Tuesday 12th June 2007

Gail EdgarService Manager

• 2005

• Rapid Response service

• Joint Partnership Agreement

• Skill Mix

Background

• Support earliest possible discharge

• Avoid unnecessary admission to hospital

• Rehabilitation : optimal independence

Aims

• Referrals to Service > Total number =over 2000

> Accepted = over 1800

• Evidence that 410 people have avoided hospital admission

• Facilitated E.S.D of 614 patients> increased availability of 3072 hospital bed

days> rapid assessment: early reduction in care

package

Statistics to date

New Developments

Concept: Continually evolve: Identified Need

• E.S.D. for COPD patients

• Development of Generic Worker role to enhance rehabilitation & clinical skills

‘Food for Thought’

March 2006 Travel Scholarship

• Australia

• Portsmouth

Potential models for Dumfries & Galloway

Silver Chain Organisation

• Personal Enablement Plan

• Health Improvement Plan

Increased support to patients at home: Generic Workers working to AHP’s.

Step Up/Step Down

• Nurse led beds in Community Units

• Rapid assessment> need for close observation> admission when necessary> early discharge - S.T.A.R.S. and AHP’s

• Supported in Community by S.T.A.R.S.> reduced hospital admissions> increased delivery of tailored rehab programme> increased potential for optimum independence

• Presence of Discharge Team member in A&E

• All older people appropriately screened and assessed

• Discharge Team member - extensive local knowledge of community services

• Identification of need: discharge follow-up

• No additional resource

PRO-ACTIVE IN-REACH PROGRAMME:A&E

REDUCTION IN NUMBER OF

ADMISSIONS & READMISSIONS

& DELAYED DISCHARGES!

RONA LAINGRONA LAINGACTING SENIOR MANAGERACTING SENIOR MANAGER

SOCIAL WORKSOCIAL WORKOLDER PEOPLEOLDER PEOPLE

SERVICESERVICE

FIFE HEALTH & SOCIAL CARE PARTNERSHIPFIFE HEALTH & SOCIAL CARE PARTNERSHIPDELAYED DISCHARGE FIFE TARGET – DELAYED DISCHARGE FIFE TARGET –

2005/062005/06

REDUCE ALL DELAYS IN HOSPITAL TO 73REDUCE ALL DELAYS IN HOSPITAL TO 73

REDUCE ALL DELAYS OVER 6 WEEKS TO 40REDUCE ALL DELAYS OVER 6 WEEKS TO 40

REPORTED DELAYS ON 15/04/06 = 71REPORTED DELAYS ON 15/04/06 = 71

REPORTED DELAYS OVER 6 WEEKS ON 15/04/06 = 21REPORTED DELAYS OVER 6 WEEKS ON 15/04/06 = 21

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP

FIFE TARGET 2006/07FIFE TARGET 2006/07 REDUCE DELAYS OVER 6 WEEKS TO 20REDUCE DELAYS OVER 6 WEEKS TO 20

REDUCE DELAYS IN SHORT STAY BEDS TO REDUCE DELAYS IN SHORT STAY BEDS TO 11

REPORTED DELAYS ON 15/04/07 OVER 6 REPORTED DELAYS ON 15/04/07 OVER 6 WEEKS = 17WEEKS = 17

REPORTED DELAYS ON 15/04/07 IN REPORTED DELAYS ON 15/04/07 IN SHORT STAY BEDS = 0SHORT STAY BEDS = 0

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP

Delayed Discharges Reported to ISD May 2006 to April 2007

0

20

40

60

80

100

120

Census Dates

Nu

mb

er

of

Pati

en

ts

Total Numbers Reported to ISD

Total Numbers Reported to ISD Over 6 Weeks

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP

ACHIEVING THE TARGETACHIEVING THE TARGET

MONTHLY VERIFICATION OF DATAMONTHLY VERIFICATION OF DATA

WEEKLY MONITORING FOR 6 WEEKS PRIOR TO WEEKLY MONITORING FOR 6 WEEKS PRIOR TO CENSUS DATECENSUS DATE

PARTNERSHIP AGREEMENT ON CODINGPARTNERSHIP AGREEMENT ON CODING

ROBUST CARE MANAGEMENT AND ROBUST CARE MANAGEMENT AND MONITORING OF PROGRESS TO DISCHARGEMONITORING OF PROGRESS TO DISCHARGE

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP

PROCESS IMPROVEMENTPROCESS IMPROVEMENT GUIDANCE ON CHOICE POLICYGUIDANCE ON CHOICE POLICY

APPLICATION OF THE GUIDANCEAPPLICATION OF THE GUIDANCE

ROLES AND RESPONSIBILITIESROLES AND RESPONSIBILITIES

JOINT ACTION PLANJOINT ACTION PLAN

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIPRESOURCESRESOURCES

HOSPITAL BASED ASSESSMENT AND HOSPITAL BASED ASSESSMENT AND CARE MANAGEMENT TEAMSCARE MANAGEMENT TEAMS

DISCHARGE SUPPORT NURSESDISCHARGE SUPPORT NURSES

SHARED I.T. SYSTEMSSHARED I.T. SYSTEMS

BUSINESS & SYSTEMS SUPPORT STAFFBUSINESS & SYSTEMS SUPPORT STAFF

FIFE HEALTH & SOCIAL CARE FIFE HEALTH & SOCIAL CARE PARTNERSHIPPARTNERSHIP

ESSENTIALS TO SUCCESSESSENTIALS TO SUCCESS

SHARED VISION/OBJECTIVESSHARED VISION/OBJECTIVES

DEDICATED STAFF TEAMSDEDICATED STAFF TEAMS

REGULAR COMMUNICATIONREGULAR COMMUNICATION

PROBLEM SOLVING APPROACHPROBLEM SOLVING APPROACH

SENSE OF HUMOUR!SENSE OF HUMOUR!

Delayed DischargeDelayed DischargeWarts and All….Warts and All….

Emerging Themes From The Emerging Themes From The 2004/5; 2005/6 & 2006/7 Census2004/5; 2005/6 & 2006/7 Census

Life is like a bowl of….Life is like a bowl of….

Two Ways of Managing a Two Ways of Managing a Census….Census…. Quarterly or Quarterly or

annuallyannually Debate the Debate the

definitions definitions Robust Robust

management management (shouting and/or (shouting and/or weeping)weeping)

Throw money at Throw money at the listthe list

WeeklyWeekly Clear Clear

understanding of understanding of reasons for delay reasons for delay allows…allows…

Constant Constant management management and…and…

Consistent funding Consistent funding decisionsdecisions

The Census Day 2004/5The Census Day 2004/5Success is…..Success is…..

Target 43Target 43 Census minus one week 78Census minus one week 78 0900hrs 390900hrs 39 1200hrs 461200hrs 46 1700hrs 371700hrs 37

What was going on?What was going on?

Accurate; Current.. “The List”Accurate; Current.. “The List”

The SW List informed the…The SW List informed the… The NHS List which was bigger The NHS List which was bigger

than above…than above… The Joint List ….had decayedThe Joint List ….had decayed The Lists not regular, but The Lists not regular, but

collected for censuscollected for census Managers didn’t hold and Managers didn’t hold and

monitor the lists.monitor the lists.

AnomoliesAnomolies

The “Long Term” DD who is not The “Long Term” DD who is not reviewedreviewed

The “compassionate” DDThe “compassionate” DD The DD with no discharge date The DD with no discharge date ““Predictable Incapax” at point of Predictable Incapax” at point of

discharge discharge Hidden DD’s and backdatingHidden DD’s and backdating Virtual DD’sVirtual DD’s

…….So For 2005/6.So For 2005/6

Agreed DefinitionsAgreed Definitions ““Amnesty” and senior sign off of local Amnesty” and senior sign off of local

agreement of listsagreement of lists Named local managers/collatorsNamed local managers/collators Changed focus for DD Action TeamChanged focus for DD Action Team Real time management information Real time management information

including value of codesincluding value of codes Management, not administrationManagement, not administration

2005/6…Success Is…..2005/6…Success Is…..

Increasing by 200+%.....Increasing by 200+%..... …….then receiving “support and .then receiving “support and

encouragement”encouragement”

NHS Highland Delayed Discharges Bed Days Lost Apr 2004 to 19 Oct 2006

(excluding 51x Patients)

0

500

1,000

1,500

2,000

2,500

3,000

2004/05 2005/06 2006/07

Delayed Discharge 2006/7Delayed Discharge 2006/7

Differential Impact on Differential Impact on HospitalsHospitals

(9)

(6)

(3)

0

3

6

9

12

15

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Comparative Delayed Comparative Delayed Discharge At End Of 2005/6Discharge At End Of 2005/62004/05 Performance2004/05 Performance Target 39 Actual 37Target 39 Actual 37 264 patients; 27,629 bed days264 patients; 27,629 bed days

2005/06 Performance2005/06 Performance Target 34; Actual 10Target 34; Actual 10 Six Week Target 19; Actual 3Six Week Target 19; Actual 3 Acute Target 5; Actual 2Acute Target 5; Actual 2 Max Wait 56 daysMax Wait 56 days 384 patients……29,582 bed days384 patients……29,582 bed days …….the wrong targets? .the wrong targets?

Performance Issues 2006/7Performance Issues 2006/7

Knowledge, awareness & late Knowledge, awareness & late startersstarters

Systems and responsesSystems and responses NHS/SW relationships and NHS/SW relationships and

engagement & pushing responsibility engagement & pushing responsibility downdown

Targeting of patientsTargeting of patients Managing now, not future ideasManaging now, not future ideas Achieved……..Achieved……..

Delayed Discharge 2006/7Delayed Discharge 2006/7

Target 28 Actual 24Target 28 Actual 24 Short stay 9 Actual 7Short stay 9 Actual 7 Six Weeks 11 Actual 9Six Weeks 11 Actual 9

Success is……Success is……

136% increase on last year??? 136% increase on last year???

OROR Actual reduction of Occupied Actual reduction of Occupied

Bed Days 15k…47%..£3.1m !!!!!Bed Days 15k…47%..£3.1m !!!!!

A Journey Through Delayed A Journey Through Delayed Discharge PerformanceDischarge Performance…..A Reality Check…..A Reality Check DisengagementDisengagement Monitoring a deteriorating Monitoring a deteriorating

situationsituation Actively managingActively managing Performing & deliveringPerforming & delivering Eye goes off ball…Eye goes off ball… ……and is brought back by weekly and is brought back by weekly

reporting regime.reporting regime.

But….But….

The system is now moving too The system is now moving too fast….fast….

Implications for balance of careImplications for balance of care Anticipatory Care?Anticipatory Care?

A Final Thought..A Final Thought..

No pudding till you finish your No pudding till you finish your greens?greens?

Delayed DischargeDelayed DischargeWarts and All….Warts and All….

Emerging Themes From The Emerging Themes From The 2004/5; 2005/6 & 2006/7 Census2004/5; 2005/6 & 2006/7 Census