Last week our CHFT Live special was all about patient flow which is the journey a patient takes from our emergency department or admission back to the place they call home.

Clinical Site Matron, Jo Oates, and Hospital at Home Manager, Emma Vant, shared how hospital and community teams work closely together to improve experience, and what part we all have to play in supporting patient flow.

Jo told us how efficient patient flow helps our patients get to the right place in a timely and appropriate way. It not only helps colleagues but often leads to a shorter length of stay for our patients and improved health outcomes as they're not waiting in our departments for long periods of time. Jo said: “For example, if a nurse on the ward is spending a lot of time on the phone getting through to wards to hand patients over, it's taking them away from the care that they deliver to our patients and slows down the flow between ED and our wards."

Jo also covered how Well Organised Ward, Urgent Community Response and the Discharge Lounge at HRI are all there to support our patients.

Emma gave an overview of the Frailty Hospital at Home service (formerly known as Frailty Virtual Ward). She explained how the service can support the medical needs of patients who don’t necessarily need to be cared for in hospital, but still need some level of medical management and monitoring. The service also helps to prevent admissions by offering consultant supervision at home, if acute care isn’t needed.

Emma said: "Studies have consistently shown that people recover better and faster at home than in hospital and this will ultimately reduce that risk of hospital acquired infections and deconditioning."

Some examples of what the Hospital at Home team monitor and manage include:

• The management of pain, titration of analgesia, daily observations, management of acute constipation, monitoring of delirium, medication adjustments and titration.
• Delivering IV fluids and antibiotics.
• Personalised care plans and packages to promote independence, exercise programmes and physiotherapy.
• In addition to consultant care, there's also access to specialist teams such as therapies, heart failure, Parkinson's, palliative care, specialist nurses and district nursing.

What were Jo and Emma's top tips?

Jo:

• Take responsibility for maintaining patient flow in your own areas and make beds available as soon as patients leave the ward
• Focus on morning discharges, and appropriate actions such as sending To Take Out (TTO) medication to pharmacy the day before discharge
• Be responsive to the Nurse in Charge to take handover in a timely manner
• Review all patients with no Criteria to Reside or who are on pathway 0. Ensure that plans are in place and use the appropriate community services to speed up the discharge process

Emma:

• Have a clear medical plan in mind, referring in a timely manner
• Make sure there's regular communication with the Hospital at Home team if a discharge is likely to be delayed so that initial visits can be rearranged, and to give a seamless transition for discharge
• Have in the back of your mind prioritising care at home, always think "can care and assessments be done at home?"

You can watch the full CHFT Live on the intranet homepage.