Taking the next steps

Traditionally, patients admitted to hospital would settle in for a stay of at least a few days, but the latest research suggests that, for older patients in particular, the shorter the time they're in hospital, the better it is for their mental health and physical recovery. All the indications are that once patients have been assessed and had any necessary treatment, home is definitely the best place for them to be.  

At County Durham and Darlington NHS Foundation Trust, which includes University Hospital of North Durham, Darlington Memorial & Bishop Auckland Hospitals, a new initiative, #NextStepHome, aims to change the way patients and their families think about being admitted to hospital. Launched in November, it's already showing positive results for patients.    

Consultant physician, Dr Paul Peter, said, "We know that patients don't want to be in hospital any longer than necessary.  For older people in particular the familiarity of home makes a huge difference to how they feel in themselves.  They can eat the food the like, when they want it, follow familiar routines  - even enjoy the comfort of a favourite chair.  Being in hospital can also feel overwhelming - everything is new. So, initially, when a patient comes to us, we ask ourselves whether admission is really necessary - can the patient receive the care they need from our community teams, at home. 

"We've also introduced Consultant Connect, a telephone service for GPs, enabling them to speak directly to our on-call consultants for advice and guidance on urgent patient issues.  In many cases, this means the GP can give the patient the care they need, or request tests on an outpatient basis, avoiding admission to hospital.  At the moment, the service is specifically for patients suspected of having an acute medicine problem or a heart, respiratory, gastroenterology or diabetes issue. GPs are already telling us they're finding it very helpful and it means patients are getting the care they need, quickly and in the most appropriate place. 

"When patients do need to be admitted we make sure they are assessed as soon as possible, including getting blood tests and results, booking scans and any other investigations needed to help us make a diagnosis.  From there, we make a plan with the objective of getting any necessary treatment in place quickly, then regularly assessing the patient's condition so that once they've made the improvements we're looking for, getting them home with packages of care, prescriptions and anything else they need, already in place. We talk to patients at every stage, keeping them updated.  It requires commitment from everyone to make it work but we have great teams who are focused and work well together.

 "One of our main aims it to help patients return to, at the very least, the level of independence they had before their admission to hospital.  All the evidence suggests this is more likely the shorter the admission.  At home, the activities of normal daily living help keep us active much more effectively than you might imagine.  But all that stops when you're in hospital and muscle strength is lost very quickly.

"We encourage patients to wear their day clothes rather than pyjamas and comfortable shoes rather than slippers.  Lots of evidence suggests patients feel much better in themselves when up and dressed and they're more likely to walk around, with help if needed.

 "#NextStepHome is also helping make sure that we have beds available for new patients requiring admission"  

Sharon Morgan, associate director of nursing for community services, comments, "Older, frailer patients, and those with long-term conditions, tell us that they want to stay at home as long as possible and return home as early as possible following an admission. As a healthcare system we're working in partnership to make this happen.  We appreciate that some patients and their families will worry about whether services in the community are robust enough to provide the care and support needed and we want to reassure them we have a menu of services available for them, including community nurses, intermediate care and domiciliary care which supports people to live independently. 

"In addition to our community teams, we work closely with GPs, specialist nurses, social workers and community physiotherapists, and therapists with other specialties, to make the transition home as safe and seamless as possible."

Jon Holmes, consultant in Emergency medicine, said, "We don't want anyone to hesitate to come to the emergency department or ring 999 when it's an emergency but we also encourage people to consider the alternatives which might be best for the patient - pharmacists  can often offer great advice about medication and symptoms, and the 111 service also offers expert guidance. 

During December 2018, over 11,000 people - that's an average of over 350 a day - used our emergency departments at Durham & Darlington.  Many needed to be there, but many others could probably have avoided attending, allowing us to focus on those most in need."

Charles Blackford, from Darlington, was taken to Darlington Memorial Hospital by his niece, when he became unwell.  Charles, 82, said, "I was assessed very quickly and had both a scan and an endoscopy, which revealed I had internal bleeding.  I was  kept up to date with what was happening and it seems some tablets I've been taking have caused the problem. I'm now on a different medication and feel very much better - a district nurse is coming to see me at home tomorrow which is reassuring.  I hadn't realised quite how unwell I was.  I came into hospital to get better which is exactly what's happened - and very quickly.  It's time to go home."

Ends

Published 3rd April