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Responding to the challenge of discharging patients during COVID-19

The COVID-19 outbreak placed an unprecedented strain on the health and social care system. A coordinated and well-managed response by MLCSU and adam has meant that patients were placed into care faster than ever before with providers able to demonstrate both compliance as well as the ability to meet the patients’ assessed needs.

Background

In March 2020 the Government published its COVID-19 Hospital Discharge Service Requirements, placing an immediate requirement on clinical commissioning groups (CCGs) to arrange the transfer of patients from hospital as soon as it was clinically safe to do so.

It was anticipated this would take no more than three hours, following discharge from the ward. At the time of the COVID-19 outbreak, MLCSU delivered a full tech-enabled CHC service to eight customer CCGs across the Staffordshire and Merseyside regions.

The solutions in place covered a population of 11.6 million, with thousands of active patients under management, and approximately 700 referrals and 360 new placements per month.

Action

MLCSU liaised with local bodies across the care sector to share important information with their providers. The team at adam took the lead in distributing communications, establishing which would be relevant to specific providers within the region. Subsequent to ths, distribution of communications could be automated, improving staff productivity.

After the intial phase was over, MLCSU and adam used their Provider Management Tool to help collect data from providers. A survey was sent out via the tool which allowed immediate distribution and management of queries and responses. The responses allowed MLCSU to create a daily dashboard to show where the virus was in the community, and thus where it was safest to move patients to.

Time to place was a key priority. Whilst the solutions MLCSU and adam deliver to CCGs accelerate the placement process, additional efforts were undertaken to improve placement speed. Whereas typically around 50% of CHC placements come from hospital, approximately 75-85% of all referrals during March and April were for patients in an Acute setting.

All patients had to be easily identified as COVID-19 patients, so the adam team amended the system within two hours to establish a new DOH stage. This allowed easier management for MLCSU and easier reclamation of funds later where appropriate.

MLCSU was able to further reduce time to place despite the case load more than doubling. With a robust and technology-enabled process, the team in place could take on the additional workload without a long lead time or extensive training.

During March and April MLCSU used the adam commissioning solution to source 1721 placements which represented a 108% increase on normal levels. A new process was established whereby the technology was used to source open care home beds for patients, with calls starting after 60 minutes to supplement the options sourced. Using data held around capacity and availability of local beds, calls were able to be focused on providers most likely able to take new patients.

Impact

With the fast response of MLCSU and adam, time to place for patients needing care homes beds decreased to a customer-wide average of three days.

With the teams working flat-out to engage local providers and ensure that patients were being kept away from local breakouts, they were still able to source two different options per patient on average.

Despite caseloads more than doubling during March and April, the time to place patients during this period was halved. As a result, providers have been able to demonstrate both compliance and the ability to meet the patients’ assessed needs.

Working at scale and underpinning process with technology has allowed CCGs to benefit from a robust and scaleable service offering, able to withstand the most serious of events.