How long does the intervention take?

Are there cost implications with regard to staffing resource and the cost of the electronic patient record?

Will my team generate more and more post-discharge enquiries via the electronic portal- is this sustainable?

Will the older patients engage with the website?

Will there be issues with information and clinical governance?

Is there a requirement for my institution’s IT department to be involved?

Do patients use the record?

The effectiveness of the intervention in trauma was measured using three indicators:

1. Unscheduled healthcare attendances following discharge
2. Patient Activation Measure® (PAM®) 10 *
3. Patient satisfaction

Final results show a significant reduction in unscheduled GP attendances in the intervention group by 20%. 37% of patients demonstrated a higher level of activation. Hospital rating scores and individual patient feedback also improved in the intervention group.

 

 

* Suzanne E. Mitchell, Paula M. Gardiner, Ekaterina Sadikova, Jessica M. Martin, Brian W. Jack, Judith H. Hibbard, and Michael K.Paasche-Orlow 2013 ‘Patient Activation and 30-day post-discharge hospital utilization’ Journal of General Internal Medicine: 29 (2), pp349-355.

 

 

North Bristol Trust is one of two Major Trauma Centres in the South West of England treating approximately 1,200 severely injured patients each year. Whilst mortality has reduced since Major Trauma Centres were introduced in 2012, post discharge and rehabilitation concerns remain the most common issues identified.

Before Quality Trauma Discharge

The discharge process had been focused solely on the patient leaving hospital rather than as an opportunity to educate and facilitate enhanced recovery. High levels of anxiety, uncertainty about provision of care post discharge and confusion about medication were frequently described at follow up as well as unscheduled healthcare attendances. Over 70% of the patients surveyed in the pre-intervention phase had visited their GP at least once in the first thirty days. Frequently these patients reported that this was because they wanted information about their injuries and about ongoing treatment: GPs are often unable to provide this.

QTD is now an integral part of the service we provide to our patients and their families. The intervention is delivered in the main by the Major Trauma Practitioners working at the Major Trauma Centre and is now being offered to both those patients discharging home and transferring to a local inpatient unit within the Major Trauma Network. Currently approximately 20-30 patients per month receive the QTD ‘package’: decisions to offer this are based on discharge plans and clinical need.

No additional staffing has been required for implementation, but the drive to offer QTD has necessitated re-evaluation and streamlining of the Major Trauma Practitioner or key worker role. There is now evident focus on the needs of each individual patient throughout their pathway beyond emergent and acute care and the preparation for this starts during early contacts turning the ‘discharge’ into a process rather than a one-off event. 

Electronic Portal – Patients Know Best (PKB)

During the development phase, the project team decided that the QTD care plans should be housed in an electronic patient-held record. Currently we are using Patients Know Best (PKB).

Through a web-based application, the PKB solution puts the patient in control of their health records and, by granting access to specific care providers, creates a single instance of the relevant care record that is available wherever the patient receives treatment. It is securely hosted within the NHS N3 network.

Allowing patients to securely access their own health information and providing them with the ability to connect health professionals and carers together in one ‘place’ enables them to take control of aspects of their own healthcare.

In the first year of using the electronic portal as our method of delivery for the AHCP we identified a consistent increase in the number of online messages that the team were receiving. It is clear that patients are using the messaging service to communicate concerns and problems to the team. 

Although the numbers weren’t formally recorded, the trauma practitioners agreed that there was a comparable reduction in the number of telephone calls made to the existing patient helpline over the same time period. This allows the team to interact with their patients and resolve their queries more efficiently. The written messages also provide both a reliable record of advice for the patient to refer back to and also a clinical audit trail. This pattern has remained consistent over the subsequent eighteen months of the QTD initiative.

QTD is now viewed by the Severn Major Trauma team as an integral part of the service we provide to our patients and their families. There is no doubt that the opportunity prior to discharge for a patient and their carers and relatives to sit down and speak with an expert professional is exceptionally valuable. People have described the experience as ‘reassuring’ and as ‘answering questions I didn’t know I had’. Our data suggests that this empowers people to be more confident in managing their care and seeking help appropriately.

The Quality Patient Discharge intervention consists of three simple, interlinked elements: 

Download sample resources:

My Way Forward document

A personalised information pack detailing patient-specific information about diagnosis, medication, outpatient follow-up and signposting the patient which way to turn with any questions or concerns. This is to reinforce information which they have already been given during their admission, not to give new information, and should act to empower patients and carers. This document can be issued as a paper copy, however, by utilising an electronic platform accessible to patients and ‘invited’ others the plan becomes a more dynamic, responsive resource for patient, carers and clinicians.  Download 

Discharge consultation

An Individualised ‘discharge counselling’ session for the patient and family or carers with an appropriately trained keyworker around twenty-four hours prior to planned discharge. A pharmacist will also see the patient at this time and give education around medication. This one-to-one time should give opportunities for any questions or concerns to be addressed prior to discharge and will be based around the ‘after hospital care plan’.
Tailoring the discharge package to the patient based on the consultation means that all of the information given, follow up arrangements, contact details and prescribing information are held by the patient or carers in one format. Download 

Two week call

Two weeks after discharge, the patient will receive a ‘check-up’ telephone call from the major trauma team during which any problems or uncertainties can be identified and appropriately managed. Download 

The NHS Five year forward view sets out an ambition to support people to shape their own healthcare, make informed choices, manage conditions and avoid complications. Evidence shows that a higher level of activation leads to better outcomes, improved experience of care and fewer episodes of emergency and unscheduled healthcare.

The Severn Major Trauma Network hosted by North Bristol NHS Trust undertook a project funded by the Health Foundation in 2015-2016 delivering a discharge intervention focused on increasing patient activation for those patients who had been treated at Southmead Hospital following serious injury. Results showed an improvement in patient activation, in patient experience and a reduction in unscheduled healthcare attendances.  Most importantly feedback from patients has been overwhelmingly positive. This is now being rolled out across the service, the network and adopted in other organisations and specialities.

Whether it’s long term conditions or a one off stay in hospital due to illness or injury every patient should have the right to be made aware of their plan for care and given opportunity to own this plan.

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Based in the Bristol Brain Centre, the Movement Disorders Research and Clinical Team, including the Deep Brain Stimulation (DBS) and Parkinson’s Disease Advanced Therapy teams, allows for a fully integrated approach to providing clinical care and offering opportunities for patients to participate in research.

The Movement Disorders team work closely on a number of regional, national and international research studies, and are developing a mixed portfolio of studies that will collectively address knowledge gaps in Parkinson’s Disease and other Movement Disorders.

Please speak to the person treating you to find out if there is a research study that may be able to help you.

 

Chief PD

SPARKS

MOVE WALES