Relieving pressure on acute beds and improving outcomes in Lincolnshire

Designing and implementing an effective model for patient discharge and flow that’s owned and championed by practitioners

February 2022 – present

£3.2m

cost avoidance

120

surgical admissions avoided per month

additional people discharged from EAU per day

Identifying new opportunities to improve outcomes and save money

United Lincolnshire Hospitals Trust (ULHT), which serves a population of around 750,000 people, was under the spotlight having only just moved out of the national Recovery Support Programme (‘special measures’).

While improvements had been made, a review commissioned by the Local Government Association highlighted ongoing issues around the implementation of national hospital discharge policy. Too many patients were being placed into acute bed wards inappropriately. The mixing and matching that became prevalent during the pandemic had left many wards with an identity crisis.

IMPOWER carried out an initial review and found a significant number of patients, with the right support, could – and should – have gone home.

After reporting our initial findings we identified targeted interventions to bring about immediate and longer-term improvements. We also developed a different approach and culture that embeds new ways of working and ultimately delivers better patient outcomes.

We adopted a ‘test and learn’ approach, working alongside staff at Lincoln County Hospital’s medical emergency assessment unit and Pilgrim Hospital in Boston. Our consultants worked on the wards with the clinical teams to build relationships and understand current practices and this enabled us to develop interventions that could be implemented immediately.

Examples included:

Introducing standardised multidisciplinary team board rounds where a range of practitioners come together on wards to consider the health, care and ultimately discharge support needs of each patient
Capturing and addressing reasons for failed patient discharges
Developing performance dashboards to monitor improvement
Introducing set times for specialists to visit wards for patient reviews and for senior medics to attend ward rounds to challenge inappropriate referrals

Creating confidence in seizing these opportunities

The key to success was ensuring staff felt a sense of ownership around these news ways of working.

We embedded a strengths-based approach that focuses on what patients and their support networks can do; built leadership in the wards; empowered ward managers to establish further new ways of working to drive improvement; and facilitated ambition-setting workshops for each ward and fostered a collective ambition across all wards.

One of the big advantages IMPOWER can bring to projects like this is our experience, reputation and existing relationships across local government and health. This gave us credibility and levels of trust that were essential to bring about change at a time when Lincolnshire was facing scrutiny at a national and regional level and dealing with financial and demand pressures.

Ultimately, it enabled us to instil confidence in the changes we were introducing and also meant we were able to challenge and push back when appropriate because we were seen as a trusted advisor throughout.

Our project lead managed the client relationship at every level to allow the rest of the team to focus on ward level work. Aside from formal, structured meetings, the team maintained constant email, phone and in-person contact with key players at an operational level to deal with issues as quickly as possible and maintain momentum.

Impact

During the initial 12-month project, we helped the client to achieve £3.2m per year in cost avoidance. This included:

An additional 4 people being discharged from Lincoln County Hospital’s medical emergency assessment unit every day compared with a year ago (equating to £2.3m)
Doubling the proportion of patients discharged directly home from the assessment unit rather than to inpatient wards
Reducing the average length of stay in winter 2022 to below summer levels – improving hospital flow during a period of heightened pressure
Avoiding 120 surgical admissions at Lincoln County Hospital in December 2022 alone (equating to £0.5m)
Increasing patient discharges from Pilgrim Hospital in Boston by 1 patient per day thanks to the introduction of midday board rounds (equating to £0.4m)

Creating a more resilient client organisation

As well as helping the client achieve the impact above, IMPOWER identified a range of interventions that together will deliver a further £1.1m per year in cost avoidance going forward.

There are clear signs of a culture-shift around patient discharge and flow and the improvements and tools introduced by IMPOWER are understood and ‘owned’ by the client’s staff. They are now taking them forward, which will not only ensure progress is sustained but also build greater resilience.

One example is the fact that the flow coordinator role we introduced to support in patients’ assessments has now been made a permanent post.

IMPOWER has since been commissioned to carry out a similar piece of work on ULHT’s surgical wards to further improve discharge and flow.