Why hospital discharge?
Hospital discharge has been identified as a national problem as highlighted in a special inquiry by Healthwatch England. In our own conversations with services, staff told us that feedback from patients on discharge was ad hoc or based on experiences from several years ago. If hospital discharge was to be improved, there was a need to know what the transfer of care was currently like for people after a stay in hospital, not just at one particular moment, but all along the recovery journey.
Tracking people's experience of going home
We decided to test out the possibility of tracking people's experiences from the moment they were ready to leave hospital for up to three months afterwards. For our Going Home pilot programme, we gather feedback from patients and their families on a weekly basis. We asked about the services people receive and their recovery journey.
So far, we have tracked people along the routes listed below.
Returning home to family care
During our Enter and View visit to St Thomas’ Hospital Older People’s Unit in September 2015, we met 92-year-old local resident who had been admitted after a fall. Based on the experiences we gathered from her and her daughter following her return home, NHS Lambeth Clinical Commissioning Group (LCCG) produced the film ‘Going Home’ (above), which was premiered at a LCCG and Healthwatch Lambeth and Healthwatch Southwark transfer of care quality summit in July 2016.
Discharge to Assess
In 2016-17 we gathered feedback from people taking part in a pilot 'Discharge to Assess' project. The pilot involved transferring patients who were medically fit for discharge to an extra care housing facility in Lambeth. Participants stayed in a furnished flat for up to six weeks to see how they managed within an independent living environment before either returning home or moving somewhere that could better meet their needs. The pilot was funded by the NHS Lambeth Clinical Commissioning Group and Lambeth Council.
In February 2017 we also worked with Healthwatch Southwark to track people's experiences of a similar pilot in Southwark involving short stays in 'step-down' flats in an extra care scheme after leaving hospital. Participants received intensive support to aid their recovery and/or an assessment to decide their next move.
King’s College Hospital Emergency Department
In the second half of 2017, we worked with King’s Engagement Team and Healthwatch Southwark to collect patient stories from older people admitted to the King’s Denmark Hill emergency department. In a lighter touch approach to the Going Home methodology, we interviewed people within days of their A&E visit to capture their feedback on A&E and then again four weeks later to track subsequent transfer of care experiences.
The Red bag scheme
To improve people's experience of hospital discharge, local hospitals have joined together with care homes in Lambeth to introduce the 'red bag' scheme. The red bag helps to provide a prompt, safe and efficient transfer of clinical care, when a resident moves between a care home and other clinical settings, such as hospitals.
It was launched in Summer 2017, so in 2018 we gathered feedback from patients who were recently admitted to hospital with a red bag to explore how they found their hospital stay, and their views on the red bag.