Trusted Assessor working in collaboration with local nursing

‘Trusted Assessor working in collaboration with local nursing homes at Barking, Havering and Redbridge University Hospital's’ Category: Integration and Continuity of Care Michelle Sheldrick Palliative Care Social Worker Ursula Abbott Palliative Care OT Heather Wright Palliative Care Team Leader

BACKGROUND • Once our patients had Fast Track funding approved and nursing home placement was the preferred place of care, it became evident that the waiting time for nursing home (NH) to assess was proving to be a timely and costly delay in facilitating discharge • We looked at ways of improving this process as we were concerned that our patients were not reaching their preferred place of care in a timely and efficient manner • Our evidence showed that our patients were waiting, on average, 5 -10 days for the nursing home to complete their assessment, thus having a significant delay in the transfer of care. This delay, on occasions, led to deteriorating health, resulting in becoming too unwell for any transfer of care

DIFFICULTIES FACED During discussions with our community nursing home colleagues, it became apparent that their difficulties were: - • Releasing appropriate staff to complete initial assessment • Accessing the relevant information • Difficult relations with the ward environment once the patient hs been discharged to the nursing home We attended community meetings with our care home colleagues to discuss any concerns and look forward to ways of improving the discharge process

TIME LINE Jan 2015: BHRUT Specialist Palliative Care Team (SPCT) took over the facilitation of fast tracks March 2017: NHS Rapid Improvement Guide to Trusted Assessors Nov 2017: BHRUT SPCT went to local care homes Dec 2017: 3 Local NH agreed to be part of pilot scheme Jan 2018 to current day: 11 NH’s over 4 boroughs in scheme

PROCESS • Firstly - to visit homes, meet managers, find out what the homes’ ethos is and what restrictions they may have • Develop a trusted relationship with homes and SPCT. This was achieved by completing initial joint assessments which led to mutual understanding • Understand the types of patients they can accept • Standardising one generic assessment form • Understanding the speciality of the individual nursing homes, ensuring seamless transition

OUTCOME Prior to starting Trusted Assessor scheme (average days until patients were discharged to nursing homes) 12 Following the scheme starting in December 2017 to current day: 15% of patients were discharged to their chosen nursing home on SAME DAY 49% of patients were discharged to their chosen nursing home within 24 hours 32% of patients were discharged to chosen nursing home with 48 -72 hours BED SAVING DAYS – BETTER FOR OUR PATIENTS, OUR FAMILIES AND OUR TRUST