How to Evaluate Discharge to Assess

How to evaluate discharge to assess

Metrics

Although discharge to assess pathways should be accessible to all patients, it is recommended that the measures below are applied to the 75+ age group as improvement is likely to have the greatest impact for these patients. Local systems may also wish to draw down the measures by specific age bands to understand differences between age cohorts.

KEY:

Green – Available from existing routine data collections

Red – Requirement for bespoke data collection

Process Measures / Outcome Measures
Checks and Balances / These are recommended so that people are not being unsafely discharged through achieving the ambitions set out in this Quick Guide. / Patient reported outcome measures
Patient mortality rates for D2A
% of re-admissions (an increase is not always a negative indicator)
Number of moves (within hospital and community)
Access to D2A pathway / All patients have access to D2A pathway.
Number of discharges on D2A pathway
Patients able to access the right service within 24 hours of being assessed as clinically optimised.
Numbers of notifications /referrals to social care/community from D2A pathway / Discharge from across the system (A+E, Acute Medical Unit, Medical Assessment Unit, Emergency Ambulatory Care, Base Wards) to usual place of residence.
Process Measures / Outcome Measures
Improved occupancy and flow within the acute hospital / Safer Care Bundle implementation[1] / Number of beds occupied by stranded adult patients defined as those with a LoS of 7 or more who are admitted via A+E
Discharge to usual place of residence from across the system
Discharge to usual place of residence on the day of their admission or the following day
Reduced hospital related falls
Reduced hospital acquired infections
Increased number of discharges
Reduction in excess bed days
Reduced number of ward transfers
Size of care packages (in both the short and long term)
Improved patient/carer experience / Process in place to record/monitor patient experience / Patients and carers reporting a positive experience of the service- Proposed questions to include:
Q1 What was good about the experience?
Q2 What could be better?
Q3 What else would you like to tell us?
Patient Reported Outcome Measures (PROMs):

European Quality of Life (5D-3L)
ICEpopCAPability measure for Older people (ICECAP-O)
Adult Social Care Outcome Toolkit (ASCOF)
End of Life Care (EoLC)

Institutionalisation/independence / D2A pathway with system-wide wrap-around care / People who are still at home 91 days after discharge from hospital (not limited to reablement)
Camden measures – total time spent at home[2]
Proportion of patients who had a Preferred Place of Death (PPD)
Rate of admissions to residential care (per 1000 population, 75+)
Reduction in DToCs in all parts of the system – measure delays in acute and community beds and community and reablement services (bridging for home care packages)
Reduced costs for system / Discharges before trim point
Reduction in excess bed-days / Bed nights (per 1000 population aged 75+)

[1]Safer Care Bundle

[2]Time Spent at home Measure – Camden