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Results for 'hospital discharge'

Results 1 - 10 of 22

Interventions to promote early discharge and avoid inappropriate hospital (re)admission: a systematic review

COFFEY Alice, et al
2019

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

Hospital to a Healthier Home: evaluation of a winter pressures pilot service

CARE AND REPAIR CYMRU
2019

An evaluation of the Hospital to a Healthier Home pilot scheme, delivered by Care and Repair, which ran from 11 hospitals between January and March 2019. The scheme aimed to support older people to be safely and more quickly discharged from hospitals to their homes and prevent them being re-admitted by making their homes safe and more accessible. This evaluation describes how the Hospital to a Health Home case worker service started, what type of interventions have been provided to patients and hospital staff, costs, benefits and the difference it has made to patient well-being, quicker safe discharges, and preventing re-admissions. The pilot involved dedicated Care and Repair case workers based at each hospital to facilitate practical improvements to a patient’s home and offer practical support on issues such as benefits entitlements. During the evaluation period: 626 patients were referred through Hospital to a Healthier Home service; 508 patients received work that helped quicker safe discharge. Based on a local assessment of bed day savings, the evaluation found that service costs are fully substantiated, and return £2.80 for every £1 invested (both revenue and capital). NHS frontline staff interviewed for the evaluation study also felt the service was of significant benefit and had the potential to deliver more.

Shared Lives intermediate care: evaluation report

NATIONAL DEVELOPMENT TEAM FOR INCLUSION
2019

An evaluation of Shared Lives intermediate care, a pilot programme to develop Shared Lives as a ‘home from hospital’ service for older people. The evaluation looks at the impact of the programme for people who are ready to leave hospital, but unable to return home. It draws on qualitative data from people in Shared Lives arrangements, Shared Lives carers, health and social care professionals, as well as data gathered from the seven pilot sites. The findings show that by the end of the Shared Lives Intermediate Care Pilot programme, which ran from October 2016-April 2019, there had been 31 home from hospital referrals into a Shared Lives arrangement. This included people with learning disability, mental health problems and physical disability. Although referrals were low, overall the evaluation demonstrate the potential benefits of Shared Lives Intermediate Care for the health outcomes of people with multiple or complex needs, in particular, people with mental health issues. Key challenges experienced by the pilots included getting health professionals to trust the Shared Lives model and make referrals. There were also capacity and resource issues, with two sites withdrawing from the pilots. The report makes recommendations for Shared Lives Schemes and services.

Reducing falls in older adults recently discharged from hospital: a systematic review and meta-analysis

NASERI Chiara, et al
2018

Background: older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods: literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results: sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. Findings: home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion: the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.

Comprehensive care: older people living with frailty in hospitals

NIHR DISSEMINATION CENTRE
2017

This review looks at the concept of 'frailty' in older people and what can be done to raise awareness amongst hospital staff, so that they can better identify and manage the needs of this ‘frail’ older people. It features 53 completed and ongoing studies funded by the National Institute of Health Research. The review covers four key aspects of caring for older people living with frailty in hospital: assessment; identifying and managing symptoms associated with frailty in hospital; discharge planning; and caring environments which consider the context in which inpatient diagnosis and treatment is delivered. The review highlights promising evaluations of workplace training and interventions. It also identifies a number of tools, such as the Frailty Index, that can help hospital staff to identify the severity of needs and help to provide targeted support. It also finds good evidence that the Comprehensive Geriatric Assessment (CGA) is a reliable way of diagnosing and meeting the needs of older people with input from multi-disciplinary teams. It also identifies areas where more research is needed, which include: maintaining activities of daily living for people admitted to hospital; and the effectiveness and cost-effectiveness of different models of delivering care. The review also includes a series of questions that hospital boards, staff and families can ask about the care of older people with frailty in hospitals. Summaries of the 53 studies are also included.

The Lightbulb project: switched on to integration in Leicestershire

MORAN Alison
2017

A case study of the Lightbulb project, which brings together County and District Councils and other partners in Leicestershire to help people stay in their homes for as long as possible. The approach includes GPs and other health and care professionals and relies on early at home assessment process at key points of entry. This is delivered through a ‘hub and spoke’ model with an integrated Locality Lightbulb Team in each District Council area and covers: minor adaptations and equipment; DFGs; wider housing support needs (warmth, energy, home security); housing related health and wellbeing (AT, falls prevention); planning for the future (housing options); and housing related advice, information, and signposting. The Lightbulb service also includes a cost effective specialist Hospital Housing Enabler Team based in acute and mental health hospital settings across Leicestershire. The team work directly with patients and hospital staff to identify and resolve housing issues that are a potential barrier to hospital discharge and also provide low level support to assist with the move home from hospital to help prevent readmissions.

The role of housing in effective hospital discharge

SKILLS FOR CARE, CHARTERED INSTITUTE OF HOUSING
2017

A collection of case studies from a wide range of housing providers, highlighting the role they can play in developing hospital discharge services. The case studies demonstrate the development of effective partnerships to meet hospital discharge needs, how these partnerships can help meet partners’ targets, and the workforce skills required to ensure effective services. Key learning points from the case studies include recognising and understanding different working cultures; building lasting relationships; effective and safe communication of information between agencies; developing sustainable and long term provision; and building a person centred solution. The publication will be particularly useful for social care and health commissioners, providers of housing and support and workforce development leads.

Reducing delayed transfer of care through housing interventions: evidence of impact. Case study

ADAMS Sue
2016

A case study and independent evaluation of a housing intervention designed to help older patients to return home from hospital more rapidly and safety. The initiative is delivered by West of England Care & Repair (WE C&R), who organise clutter clearance/deep cleaning; urgent home repairs, emergency heating repairs and essential housing adaptations for older people in hospital. The evaluation examined all case records, interviewed 15 hospital staff and undertook an in depth analysis of a sample of 4 cases. Analysis of the case records estimated a saving in hospital bed days of £13,526. The cost of housing interventions was £948, resulting in a cost benefit ratio of 14:1. Additional savings in hospital staff time amounted to a further £897. A short case study illustrates how the service was able to help one woman return home from hospital. It concludes that the small scale evaluation is indicative of the potential savings that a practical and effective home from hospital housing intervention service can generate for the health service.

Integrated care for older people with frailty: innovative approaches in practice

ROYAL COLLEGE OF GENERAL PRACTITIONERS, BRITISH GERIATRICS SOCIETY
2016

Joint report showing how GPs and geriatricians are collaborating to design innovative schemes to improve the provision of integrated care for older people with frailty. The report highlights 13 case studies from across the UK which show what an integrated health and social care system looks like in practice and the positive impact it can have. The case studies are grouped into three areas: schemes to help older people remain active and independent, extending primary and community support to provide better services in the community, and integrated care to support patients in hospital. The examples cover a range of locations across the UK, including urban and rural populations, and a range of settings, including services based in the community, in GP practices, in care homes and in hospitals. Whilst the majority of the initiatives led by GPs or geriatricians, they illustrate the vital role that many other professionals play, including nurses, therapists, pharmacists and social workers. The report also outlines some common themes from the case studies, which include person-centred care, multidisciplinary working, taking a proactive approach and making use of resources in the community.

Quick guide: supporting patients' choices to avoid long hospital stays

NHS ENGLAND, et al
2016

This quick guide provides practical advice to help local health and social care systems reduce the time people spend in hospital when they no longer need acute care, but are delayed whilst making decisions about or making arrangements for their ongoing care. The guide covers: providing people with information about their choices after hospital discharge, providing support to allow patients to make choices about their ongoing care, the availability of care homes and care packages at home, a patients refusal to leave hospital, and use of interim packages and placements. Each section includes a checklist of actions to consider to help identify areas for improvement and examples of practical solutions to common problems, including links to useful resources. A template policy and template patient letters that can be customised and used locally are also included.

Results 1 - 10 of 22

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News

Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation

KOMP

KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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