Where Best Next Campaign: Reducing Length of Hospital Stay (NHS England)

Summary

Approximately 350,000 patients spend more than three weeks in a hospital each year, often with poor outcomes:

“Many older people, particularly those who are frail and may have dementia, actually deteriorate while in hospital – a stay of more than 10 days leads to 10 years’ muscle ageing for people most at risk”. NHS England / NHS Improvement, June 2019.

NHS England has launched the “Where Best Next?” campaign, also known as “Why not home? Why not today?”, encouraging NHS staff to reduce avoidably long hospital stays for patients.

The central principles are:

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Reference

Reducing long stays: Where best next campaign. [Online]: NHS England, August 16th 2019.

See also:

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Reference

Reducing length of stay. [Online]: NHS England, circa 2019.

Action Cards for Different Healthcare Professionals

A set of action cards highlights important considerations to reduce long hospital stays, tailored for specific professional groups:​

For Doctors:

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Reference

Reducing long stays. Why not home? Why not today?: action card for Doctors. London: NHS England, August 16th 2019.

For Nursing Associates:

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Reference

Reducing long stays. Why not home? Why not today?: action card for nursing associates. London: NHS England, August 16th 2019.

For Pharmacy Teams:

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Reference

Reducing long stays. Why not home? Why not today?: a guide for pharmacy teams. London: NHS England, August 16th 2019.

For Registered Nurses:

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Reference

Reducing long stays. Why not home? Why not today?: a guide for registered nurses. London: NHS England, August 16th 2019.

For Physical (and Other) Therapists:

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Reference

Reducing long stays. Why not home? Why not today?: a guide for therapists. London: NHS England, August 16th 2019.

Case Studies Illustrating Reducing Length of Stay Principles

There are a few case studies showing how the main reducing length of stay principles have been put to the benefit of patients.

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Reference

Putting the principles into practice: Principle 4. Embed multidisciplinary team reviews. Kettering General Hospital NHS Foundation Trust. London: NHS England, August 14th 2019.

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Reference

Putting the principles into practice: Principle 3. Establish systems and processes for frail people and their families. South Warwickshire NHS Foundation Trust. London: NHS England, August 14th 2019.

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Posted in Acute Hospitals, Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Local Interest, Management of Condition, National, NHS, NHS England, NHS Improvement, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Practical Advice, Quick Insights, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Refusal and Resistance to Care in People With Dementia in Acute Hospitals (Patient Experience Library / NIHR / International Journal of Nursing Studies)

Summary

Patients with dementia often have a poor experience of care in hospitals. Some hospitals are better than others, almost certainly, thanks to improvements in dementia-friendly hospital care, appropriate staff training and dementia awareness raising; however certain problems may persist in the best of NHS institutions.

A recent report covers detailed qualitative (ethnographic) research exploring the phenomenon of resistance, refusal or rejection of care by people living with dementia on wards on five acute NHS hospitals in England and Wales. Hospitals are places with routine-based ward cultures involving timetabled mealtimes, medication rounds, planned personal care etc. but such routine ward cultures are often found to trigger patient resistance in this patient group; commonly resulting in less than satisfactory outcomes for all parties:

“Cycles of resistance in response to organisationally mandated timetables of care can result in poor care experiences for patients, and emotional and physical burnout for staff”.

The researchers advise:

  1. Recognising that people living with dementia are a significant population within acute wards.
  2. Recognising the need to train acute staff appropriately.
  3. Recognising the potentially adverse impact of fixed timetables of care.
  4. Improving the understanding of refusal and resistance to care.
  5. Developing appropriate responses; reducing use of patient restraint.
  6. Challenging low expectations of ward staff concerning people living with dementia.

Full Text Link

Reference

Refusal and resistance. [Online]: The Patient Experience Library, August 13th 2019.

This relates to:

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Reference

Featherstone, K. Northcott, A. [and] Harden, J. [et al] (2019). Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Southampton: NIHR Journals Library / Health Services Delivery Research. March 2019; Vol.7(11).

Possibly also of interest, from members of the same team:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Featherstone, K. Northcott, A. [and] Bridges, J. (2019). Routines of resistance: an ethnography of the care of people living with dementia in acutehospital wards and its consequences. International Journal of Nursing Studies. August 2019; Vol.96: pp.53-60.

Poorer Outcomes Arising From Hospitlisation of the Cognitively-Impaired: on Every Front?

Basic context – room for continuing improvement:

“Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions”.

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Reference

Fogg, C. Meredith, P. [and] Culliford, D. [et al] (2019). Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: a retrospective cohort study. International Journal of Nursing Studies. August 2019; Vol.96: pp.1-8.

Posted in Acute Hospitals, Commissioning, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Mental Health, Models of Dementia Care, NHS, NIHR, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, UK, Universal Interest, Wales | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Digital Support for People At Risk of Type 2 Diabetes (NHS England / Diabetes Care)

Summary

Online support and wearable monitoring technology will be provided for eligible people at risk of developing Type 2 Diabetes, as part of planned extensions to the NHS Diabetes Prevention Programme. This complies with ambitions in the NHS NHS Long Term Plan.

“One in six hospital beds in England are occupied by someone with Type 2 diabetes, which leads to more than 9,000 amputations each year and the NHS spends more than £6 billion annually treating the condition and its complications”.

Full Text Link

Reference

Digital diabetes prevention rolled out as part of NHS Long Term Plan. [Online]: NHS England, August 12th 2019.

More on the Association Between Type 2 Diabetes and Vascular Dementia Risk

Possibly also of interest, a recent study discovered that Type 2 Diabetes is associated strongly with the risk of developing vascular dementia, but not Alzheimer’s Disease.

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Doney, ASF. Bonney, W. [and] Jefferson, E. [et al] (2019). Investigating the relationship between Type 2 Diabetes and dementia using electronic medical records in the GoDARTS Bioresource. Diabetes Care. August 7th 2019. [Epub ahead of print].

Posted in Commissioning, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Management of Condition, National, NHS, NHS England, Person-Centred Care, Personalisation, Public Health England, Quick Insights, Scotland, Standards, Statistics, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Review of Community-Based Services Designed to Avoid or Delay Residential Care Home Admissions (BMC Geriatrics)

Summary

An Australian systematic review investigated the effectiveness of community-based care interventions for the elderly in terms of their role in avoiding or delaying admission to residential care. It was found that multi-factorial, individualised community programmes are more effective, while “minimal” single-focus interventions are less effective, at helping older people to remain living in their own homes.

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Reference

Luker, JA. Worley, A. [and] Stanley, M. [et al] (2019). The evidence for services to avoid or delay residential aged care admission: a systematic review. BMC Geriatrics. August 8th 2019; Vol.19(1): 217.

Posted in Commissioning, Community Care, Falls Prevention, For Carers (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Integrated Care, Management of Condition, Models of Dementia Care, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Systematic Reviews, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

NHS Mental Health Implementation Plan: the Next Five Years (NHS England)

Summary

The NHS mental health implementation plan outlines the framework to deliver the mental health commitments of the NHS NHS Long Term Plan. There is an explanation about support for local areas from NHS England and NHS Improvement to improve access to mental health care.

The main section headings in the plan comprise:

  • Section 1: Overview
    • Summary of Five Year Forward View for Mental Health and Long Term Plan commitments
    • Planning approach.
    • ‘Fixed’, ‘flexible’ and ‘targeted’ approaches to delivering mental health commitments in the NHS Long Term Plan.
    • Workforce.
    • Financial transparency.
    • Advancing mental health equalities.
    • Opportunities for Voluntary, Community and Social Enterprise (VCSE) Sector leadership in delivery and implementation.
    • Alignment with other priority areas in the NHS Long Term Plan.
  • Section 2: Implementation Plan for Mental Health
    • Perinatal Mental Health.
    • Children and Young People (CYP) Mental Health.
    • Adult Common Mental Illnesses (IAPT).
    • Adult Severe Mental Illnesses (SMI) Community Care.
    • Mental Health Crisis Care and Liaison.
    • Therapeutic Acute Mental Health Inpatient Care.
    • Older People’s Mental Health.
    • Suicide Reduction and Bereavement Support.
    • Problem Gambling Mental Health Support.
    • Rough Sleeping Mental Health Support.
    • Provider Collaboratives (formerly ‘New Care Models’) and Secure Care.
    • Digitally-Enabled Mental Health Care.
    • Improving the Quality of Mental Health Data.
  • Appendices
    • Annex A: Mental Health Programme Financial Profile.
    • Annex B: Indicative Workforce Profile (by Staff Group and Programme Area).

Full Text Link

Reference

NHS Mental Health: Implementation Plan 2019/20 – 2023/24. London: NHS England, July 2019.

Posted in Acute Hospitals, Commissioning, Community Care, Depression, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), In the News, Integrated Care, Local Interest, Management of Condition, Mental Health, Models of Dementia Care, National, NHS, NHS England, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Standards, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Dementia-Friendly Extra Care Housing: a Compendium of Best Practice (Housing LIN)

Summary

A Housing Learning and Improvement Network report provides a compendium of case studies illustrating good practice in extra care housing schemes and other housing-related community-based services. The focus is on supporting people with dementia to maintain meaningful relationships and reduce loneliness or social isolation.

Full Text Link

Reference

Twyford, K. [and] Wells, W. (2019). Going the extra step: a compendium of best practice in dementia care. London: Housing Learning and Improvement Network (Housing LIN). July 29th 2019.

Posted in Charitable Bodies, Commissioning, Community Care, For Carers (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), For Social Workers (mostly), Housing, Housing LIN, Integrated Care, Management of Condition, Mental Health, Models of Dementia Care, Non-Pharmacological Treatments, Person-Centred Care, Personalisation, Quick Insights, Standards, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Review of Socially Assistive Robots (Journal of Medical Internet Research)

Summary

A recent systematic review of the literature on the uses and efficacy of socially assistive robots (SARs) notes that the limited evidence to date in the field of mental health focuses largely on applications of SARs for elderly persons with dementia. There is ample scope for further research.

“ …existing studies of the potential impact of SARs on psychological well-being are limited in generalizability, scope, and measurement”.

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Reference

Scoglio, AA. Reilly, ED. [and] Gorman, JA. [et al] (2019). Use of social robots in mental health and well-being research: systematic review. Journal of Medical Internet Research. July 24th 2019; Vol.21(7): e13322.

Posted in Acute Hospitals, Assistive Technology, Community Care, For Carers (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), International, Mental Health, Models of Dementia Care, Non-Pharmacological Treatments, Personalisation, Quick Insights, Systematic Reviews, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment