Managing Frailty and Delayed Transfers of Care in the Acute Setting: A call to get involved!

Debbie Hibbert  leads on the NHS Benchmarking Network’s community sector benchmarking projects, manages the Delayed Transfers of Care / Older People’s benchmarking projects, is the Project Manager for the National Audit of Intermediate Care (NAIC), and the National Audit of Care at the End of Life (NACEL). She tweets @Debbie_NHSBN 

In this blog, the Managing Frailty and Delayed Transfers of Care in the Acute Setting project is described. Clinicians are encouraged to get involved with this project, the outputs of which include a bespoke report for participants and access to an online benchmarking toolkit. To receive your log in details or for further information, please contact josh.davies@nhs.net.

Driving quality improvements in the care of older people remains a key issue for the NHS as the population of the UK ages. The NHS Benchmarking Network is back with another project following on from previous work on the care of older people, and delayed transfers of care.  The new project continues the Network’s six-year partnership with the BGS and will help our members to gather much needed data to inform service change and future strategic decisions.

The project provides a unique data set on the pathway of frail older people through secondary care, from assessment in A&E, assessment units, inpatient wards and supported discharge. The project gives insight into why this cohort of patients appear to be more prone to delayed transfers of care. The BGS has also worked with the NHS Benchmarking Network to develop a short service user audit which will be included in the project.

47 acute hospital providers in England and Health Boards in Wales took part in the 2016 benchmarking project collecting 2015/16 data. Three key messages emerged from the 2016/17 project that impact on the quality of care delivered for older people;

• The use of Comprehensive Geriatric Assessment (CGA) is increasing;
• Readmission rates are rising;
• Delayed transfers of care continue to grow.

Further findings from the Older People’s Care in Acute Settings 2016 project (2015/16) data include:

• 40% of organisations have a dedicated geriatric team located in the A&E department. The average number of hours that these teams are available during the week is 9 hours; at weekends this reduces to 6 hours.
• 77% of trusts delivered Comprehensive Geriatric Assessments on the care of older people wards, and 42% delivered these assessments on other specialty wards.
• The ratio of qualified to unqualified nursing staff on the care of older people wards was found to be 55% registered and 45% unregistered. The RCN recommends a ratio of 65:35 skill mix for “ideal, good quality care,” and 50:50 for “basically safe care” across the participants (Safe staffing on older people’s wards, RCN, 2012).
• The average time for a continuing healthcare assessment to be undertaken is 10 days.
• 74% of organisations set estimated discharge dates within 24 hrs of admission.
• 14% of pay costs spent on bank & agency across the pathway.

Partly as a result of the findings of our 2016 project and the burgeoning national focus on NHS delays, in 2017/18 the project took a deeper dive into the issue of delayed transfers of care. 67 member organisations covering 97 submissions across England, Wales and Northern Ireland participated in the 2017 pilot.

Key findings for acute trusts from the Delayed Transfers of Care 2017 project include:

• Longer lengths of stay are associated with older people. The mean length of stay for an emergency admission for different age groups is 5 days (all ages), 6.4 days for the 65 – 74 age group, 8.4 days for the 75 – 84 age group, but increases to 10.5 days for the 85+ age group.
• On average, across participating trusts, the days lost to DToCs represent 4.8% of occupied bed days (over 2016/17).
• The DToC target of 3.5% of occupied bed days set by NHS England was not met in 70% of trusts and 69% of providers reported an increase in DToCs in 2016/17.
• The main reasons for DToC across all age groups in acute providers are awaiting completion of assessment (18%); awaiting further non-acute care (20%), awaiting a care home placement (22%) and awaiting a care package in their own home (18%).
• When the DToC reason is reviewed for the 85+ cohort only, the picture changes – awaiting a care home placement is a reason in almost a third of cases (29%); awaiting a care package in own home is 18% and awaiting family choice is 19%.

Participating organisations have access to a comprehensive online benchmarking toolkit, allowing them to view their positions on hundreds of metrics covering service models, activity, workforce, finance and quality and outcomes across the acute pathway. Participants also receive a bespoke dashboard report, comparing their peer organisations, and highlighting their position against a range of summary metrics. Your organisation can register through the Network’s members area, which can be accessed here.

Data collection is now open, there will be a free to attend findings event for Network members to be held on the 7^th of February and the rest of the project’s outputs will follow shortly after. For more information on this benchmarking project, please contact Josh Davies, Project Coordinator, josh.davies@nhs.net.