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Moving healthcare closer to home: case study: Short-Term Assessment, Rehabilitation and Reablement Service: London North West Healthcare NHS Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 6
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. Short-Term Assessment, Rehabilitation and Reablement Service (STARRS) provides acute-level care in the patient’s home. It avoids admissions and enables early discharge from acute hospitals by responding rapidly to referrals from GPs and identifying patients for discharge from A&E departments and inpatient wards. Important features are cross-skilled staff and integration within the acute hospital. The STARRS team includes nurses, therapists, social workers and consultants with support from the SPA (single point of access) team that manages administration. (Edited publisher abstract)
Moving healthcare closer to home: case study: Midhurst Macmillan Palliative Care Service: Sussex Community NHS Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 5
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Midhurst Macmillan Palliative Care Service provides acute-level care at home to patients nearing the end of their lives. Important features are personal case management to co-ordinate all aspects of care, a seven-day service and cross-skilled staff. Patients are assessed for psychosocial, medical and social needs at the same time. Single assessments help reduce stress and accelerate care planning. Counsellors work with patients and families before and after bereavement. (Edited publisher abstract)
Moving healthcare closer to home: case study: Rapid Response Service: Central and North West London NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 6
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Rapid Response Service enables patients who are entering crisis to remain supported in their home or the community, rather than be admitted to hospital. The service also helps patients who have been admitted to hospital to return home as soon as possible. Features include overnight staffing and the service’s interdependencies with other trust teams to meet patient needs. The service offers short-term intensive support for up to 10 days, including nursing and therapeutic assessments and social care. Care is provided mainly at home, enabling patients to safely regain independence as quickly as possible. After 10 days, the team supports the referral of patients to other appropriate services. (Edited publisher abstract)
Moving healthcare closer to home: case study: Discharge to Assess: South Warwickshire NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 6
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Discharge to Assess (D2A) service enables patients to be discharged earlier from acute inpatient wards by co-ordinating care in alternative settings. Important features include the trusted assessment between health and social care, in-house reablement and rehabilitation, and care co-ordinators to support patients and their families throughout the discharge process. (Edited publisher abstract)
Moving healthcare closer to home: case study: Enhanced Rapid Response Service: Kent Community Health NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 4
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Enhanced Rapid Response Service (ERRS) helps patients in crisis avoid a stay in an acute hospital where clinically appropriate. After initial clinical triage, the service assesses the patient in their own home where medical, nursing and therapy support is then given. Important features of the service include leadership by the consultant geriatrician, who manages a team of specialty doctors and enhanced practitioners, and an engagement programme with primary care, the mental health trust, social care and the ambulance trust to boost uptake of the service. (Edited publisher abstract)
Moving healthcare closer to home: case study: Early Supported Discharge Service: Countess of Chester Hospital NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 3
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. The Early Supported Discharge (ESD) Service enables acute hospital patients to be discharged in a timely way by making sure care packages are in place to support their rehabilitation at home. An important feature of the service is the strong partnership with the local community trust. The team comprises nurses and therapists, including occupational therapists and physiotherapists, as well as a social care assessor. Increasing numbers of community support workers can provide care, rehabilitation and support in the patient’s home while awaiting social care packages. Staff are employed by an integrated community and acute therapy service. (Edited publisher abstract)
Moving healthcare closer to home: summary
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 12
- Place of publication:
- London
Summarises the findings of a project examining examples where provision of non-elective care moved from an acute hospital to the community. The Five Year Forward View has encouraged efforts to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better care for patients, cutting the number of unplanned bed days in hospitals and reducing net costs. Drawing on the lessons from a set of case studies, this analysis shows that: well-designed schemes to move healthcare closer to home can deliver benefits in the long term; it is difficult, however, to cut costs across a local health economy in the short run; and better data and improved pricing would help. The paper is part of a suite of materials developed to support providers and commissioners making decisions about schemes to move healthcare currently provided in acute hospitals to community-based settings. (Edited publisher abstract)
Moving healthcare closer to home: case studies: enabling early discharge
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 11
- Place of publication:
- London
This paper is part of a suite of materials developed to support providers and commissioners making decisions about schemes to move healthcare currently provided in acute hospitals to community-based settings. It presents two case studies illustrating how services and schemes can support early discharge. The Early Supported Discharge Service (Countess of Chester Hospital NHS Foundation Trust) enables acute hospital patients to be discharged in a timely way by making sure care packages are in place to support their rehabilitation at home. The Discharge to Assess (South Warwickshire NHS Foundation Trust) enables patients to be discharged earlier from acute inpatient wards by co-ordinating care in alternative settings. Important features include the trusted assessment between health and social care, in-house reablement and rehabilitation, and care co-ordinators to support patients and their families throughout the discharge process. (Edited publisher abstract)
Moving healthcare closer to home: case studies
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 75
- Place of publication:
- London
This paper is part of a suite of materials developed to support providers and commissioners making decisions about schemes to move healthcare currently provided in acute hospitals to community-based settings. It presents 15 case studies that describe schemes to avoid hospital admissions, enable early discharge or reduce length of stay through improving acute pathways. (Edited publisher abstract)
Moving healthcare closer to home: case study: Care Navigation/Telehealth Care Services: South West Yorkshire Partnership NHS Foundation Trust
- Author:
- MONITOR
- Publisher:
- Monitor
- Publication year:
- 2015
- Pagination:
- 4
- Place of publication:
- London
This is one of a suite of case studies designed to increase awareness of schemes to move healthcare closer to home. Telehealth monitoring in patients’ homes in Barnsley helps reduce hospital readmissions and length of stay by enabling patients to better understand their illness and take more responsibility for managing their long-term conditions at home. Important features include remote data-monitoring and close partnership working with the local authority. A telehealth unit is installed in the patient’s home and they are trained to upload daily data on their vital sign readings, including blood pressure, concentration of oxygen in the blood and weight. Telehealth is integrated with the local authority's Independent Living at Home service and aims to provide seamless social care as well as healthcare. (Edited publisher abstract)