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Top tips for using digital to support capacity and flow in hospital discharge

The ideas presented here are intended to support those trying to create more capacity and better flow and to specifically unblock delays in hospital discharges.

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Principles

The ideas presented here are intended to support those trying to create more capacity and better flow and to specifically unblock delays in discharges by:

  • better supporting more simple discharges and helping with confidence-building (P0)
  • helping to make mobile workforce deployment more  efficient (P1&2)
  • ‘Making care go further’ – complementing home care face to face visits or care home staffing requirements with other forms of contact or monitoring safety and wellness, leaving the human contact to do what only people can do (P1-3)
  • using digital technology to provide virtual wards, to take more complex care safely off wards (P1-3).

Unlocking digitisation to create capacity  

Understand your processes and where you can use digital to save time, gather information, share information and remove duplication from your processes. Talk to people to understand the process. Review the process from the individual’s perspective – it will help you trace the whole process from start to finish. 

Look to create and use one version of the truth so that everyone across the system knows what is going on. Often delays occur when different teams are working to different information. The Digital Discharge to Assess project worked with councils to find a solution.

People are most important when introducing digital. Everyone needs to feel a real benefit to commit to a change in how we work – you need to fix at least one problem for every stakeholder to see effective uptake. Work as a whole team to introduce digital solutions. Listen to the team. Plan with them, train them, support them, listen to them again. View digital culture change resources for information.

Work with teams to resolve discharge blockages. Make sure someone is responsible for digital in each team and that they are a key decision-maker with managerial responsibilities and accountability for performance. It is impossible to lead from the sidelines.

Share the benefits from technology across professionals and families to help ease the load. Home monitoring technologies can help both groups know when to intervene. Be clear on who is doing what - include loved ones role in the care delivery. 

Supporting pathway zero (more simple discharges) and prevention

There are easy everyday gadgets to help people and carers support themselves. Use voice activated devices such as Amazon ‘Alexa’ to perform tasks such as setting reminders (e.g. medication), providing news updates, managing shopping lists and playing audiobooks or music. Some training can help get the most out of the devices. Similar functionality is available on Apple and Google smartphones.

The simplest solutions could simply be to include a large button telephone (Ownphone) to connect to an urgent call centre once discharged, possibly as part of a 'telecare in a bag' kit.

Consider GPS location apps or products that can help people outside of their home environment too. Websites such as AskSARA or LivingMadeEasy have easy to search solutions.

Automated telephone calls increase staff capacity and proactively identify issues before people reach crisis. This model has been used for Community Equipment Loan Service and could easily be adapted to provide follow up after hospital discharge.

Use digital technology in a preventative way. Don’t wait to use solutions, they can be used to identify deterioration and prevent hospitalisation to begin with. Many of the solutions described overleaf can also be used preventatively.

Supporting pathway one (going home with social care support or reablement)

Personal alarms (that use wearables) are the simplest, proven help for those at risk of a fall or an emergency. That emergency can be something simple like not being able to get off the toilet and is not a medical emergency. 

Innovative smart home monitoring systems use an array of motion detectors to monitor activity in your loved one’s home. If someone is inactive, the temperature drops or they forget to take their medicine or close the front door, a notification is sent to a pre-arranged device or system so help can be accessed.

See an example virtual smart home.

Sometimes home care agencies can run in a more efficient way and capacity can be better optimised through care planning and scheduling tools. They support skills, proximity, care continuity, availability

Digital solutions for workforce recruitment have also been developed with local government as part of NHS Digital and LGA SCDIP funding resulting in ME Passport to assist in portability of workers across the system.

e-MAR systems can support pathways 1-3. Electronic medical administration records enable a better standard of care through improved delivery of medication. 

Supporting pathway two (intermediate care bedded)

A video ‘carephone’ or tablet can allow care workers, family members and other approved services to be able to contact the recipient and vice versa through a video call. The tablet device, which is small enough to carry around the home, also has several additional functions which can be set up remotely including: reminders (such as medications, getting dressed, drinking fluids, doing exercise), video/virtual “eyes on” to see any changes in services users if they are unwell, enable professionals to ask users about personal tasks (e.g. “have you applied your cream to your leg”) or texts to the device, for example “your therapist or carer is running late”. Digital devices may allow people to reduce their length of stay in bedded intermediate care services and return home.

Supporting pathway three (care homes – residential or nursing)

The more resilience that can be built into the care home environment in terms of digital safety management, the less homes need to call on additional staffing requirements.

Today’s menu of digital support includes a wide variety of relatively easy to implement digital tools. NHS England offer a care home technology quick guide with loads of resources. Care homes are becoming used to technology being supplied to support remote blood pressure monitoring, pulse oximeters, and digital thermometers to support the NHS to provide clinical care.

Acoustic monitoring uses sensors and AI to monitor care home residents when alone in their rooms during the night. The system alerts staff instantly when residents require care, freeing staff from regular checks that often wake up sleeping residents.

Evidence suggests up to 40 per cent of staff time is saved during the night, it reduces resident falls up to 55 per cent and decreases hospital visits up to 20 per cent.

Digital Health Call systems support electronic referrals into community health and primary care services but also remote monitoring of residents. Such systems also allow the creation and sharing of baseline observations. Some systems include management of tissue care and nutrition and hydration. See ‘The Digital Care Home’

Digital to support virtual wards

Virtual wards are a means of providing clinical level support outside of hospital settings and can free up valuable ward space. 

They should be technology-enabled to maximise the opportunity they offer for patients, carers and staff. Technology-enablement means the management of patients via a digital platform. In a technology-enabled model, patients measure agreed vital signs and enter data into an app or website. In some cases, they wear a device that continuously monitors and reports vital signs.

NHSx provide specific advice and support around virtual wards

The digital platform ‘Lucy’ can be used as a Virtual Triage Solution | Virtual Lucy. This incorporates an Integrated Rehabilitation app (Desktop, IOS, Android), which allows for customised rehab plans, interactive chat function and pain score flag so the clinician and patient can keep track of progress.  

See also slide deck on virtual wards for more information

Tips for picking and managing a digital technology partner

  • Pick a digital provider with experience of our sector
  • Think through what you want your outcomes to be and use this as your foundation. View digital benefit realisation resources for more information 
  • Don't be dazzled by features or good sales teams; make sure you're clear on what you need and find a product or products that meet this need
  • But a company who is willing to develop alongside you can also be good
  • Solutions can be simple and don’t have to be “new”. Proven technologies with immediate wins can help quickly and easily support services without having to change hearts and minds
  • Pick a digital provider who is available at the end of the phone. One point of contact, who works with you to problem solve, and support you through it
  • Think to the future – technology needs maintenance and it constantly evolves. Additional purchases can slow everything down
  • Pick a company who includes maintenance, repair, upgrades in the cost. You don’t want any hidden charges.