Heather McAndrew has been HCPA’s Lead Social Care Trusted Assessor working with the Lister Hospital, Stevenage and East and North Hertfordshire’s 92 care homes as part of the NHS Vanguard Programme.
This ground-breaking service, designed to ease the discharge process from hospital to residential care and nursing homes, has now been running for two months and saved a total of £16,275 through preventing delayed discharges.
The below case study shows how Heather’s effective work enabled the safe and seamless transition of one elderly service user back to her care home.
“I was alerted via the care home that their service user was to be discharged shortly.
This care home specifically requested me to conduct an assessment on their behalf as they were unable to assess until Friday afternoon due to their care home demands and shortage of staff. The Manager had also raised the point that if the resident was to return, it would need to be at a specific time and date, as they had limitations outside of these requirements. There was, therefore, a potential that this patient would not be able to return until the following Monday.
The assessment was conducted and once complete, I informed the home and provided them with a copy of my findings. Given the detail within my assessment, the care home agreed to accept this resident back. The service user was deemed ‘medically fit for discharge’ and it was documented that the service user could return as an ‘out-patient’ for a colonoscopy due to her diverticulitis and loose stools.
On arrival to the ward the next day, the doctors were in discussion about getting her to have a ‘quick’ colonoscopy at around 10am, before her transport arrived. I intervened into their conversation, and questioned if this colonoscopy was now urgently needed, given the notes stated that she could have one as an ‘out-patient’.
I emphasised that this lady had been in hospital since July, and that all practical steps had been made to ensure her safe discharge for that morning. Due to the hospital pressures and lack of beds, I questioned whether it was suitable to create a possible delay by scheduling her in for a routine scope that may well be delayed/cancelled due to high hospital demands; to which, she would then miss her transport and the home would not be able to accept her back until the following week because of their time restraints.
The doctors and I reflected together on this individual, her needs, her safety and her wish to return to her residential home and they agreed for her to undertake the colonoscopy as an ‘out-patient’ as this was no means an emergency or urgently required.
Working effectively and reflecting on practice with all multi-disciplinary teams, we were able to transfer the patient without further unnecessary delay.
Reflective practice is key to provide the maximum and most beneficial outcome for the service users under your care.”
For any information regarding the trusted assessor, you can contact Heather directly on email@example.com or by calling HCPA on 01707 536020