Over the last two weeks, Pulse Online has focussed on the discharge without delay (DwD) programme. We have highlighted two animations: explaining what DwD is and a short clip highlighting where practitioners can find more support.
In this third and final update in the series, we look at frequently asked questions (FAQs).
What is the discharge without delay (DwD) programme, in a nutshell?
The DwD programme aims to improve the patient journey, from the initial point of a hospital stay, preventing any delays through early and effective planning. A key aim is to limit hospital stays to what is clinically and functionally essential, getting patients home at the earliest and, crucially, safest opportunity.
DwD is not a new idea. The change is based, however, on an improved system of working, with smoother, more seamless links between NHS staff, the hospital-based social care workers and the community team.
What challenges does a delay in the health and care system pose?
As people continue to live longer, our hospital and community infrastructure faces a continual balancing act to manage the weight of growing demand and complexity.
During the pandemic, staffing challenges, availability of resources and increased acuity of people both in hospital and in the community have added significant additional pressure on our health and social care system. If the flow through hospital is disrupted for whatever reason, or services required for discharge are not available, people can be delayed in their journey. Equally, when community services are unable to respond, often an admission to hospital is seen as the only option.
Streamlining the inpatient journey is a challenge not unique to Scotland or the UK, but one that is pronounced across developed Europe.
Whether we are looking at Borders or Bruges, the statistics represent a plethora of often heart-breaking human stories. We know from feedback that when someone goes into hospital, invariably the first question that is asked is ‘when am I going home?’ The majority are simply very anxious of the unfamiliar and the unknown.
As well as the impact on emotional wellbeing, disrupted delay can have serious consequences for health. For an older person, studies have shown that three weeks in bed reduces fitness equal to 30 years of aging.
Deconditioning can exacerbate further delay, as care requirements increase the scope for returning home can diminish. This vicious circle leads to poor patient outcomes and adds even more pressure onto the system – and those who work within it.
Crucially, where there is an ‘exit block,’ poor experience and outcomes, there is a recognised corresponding ‘access block’ to the hospital system. In turn, there is a significantly increased risk of morbidity for patients who experience long waits for admission in our emergency departments.
How do we approach this challenge?
What we cannot do is keep building more hospitals to cope with this demand. Even if we built physical hospitals, we do not have the numbers of people to staff them. We are not powerless in the face of such challenges, we can all play a part in improving the patient and staff experience through our DwD programme – which engages health and social care in enhancing the discharge journey and preventing delays.
In essence, DwD puts the patients at the centre of planning for discharge, preventing delay where at all possible. Reducing delay has many benefits – for those patients in bed now, and for those who require admission.
What are the basic elements of DwD?
While the challenge is highly complex, ever shifting and dynamic, the foundations of DwD are based on simple patient-centred principles which aim to enhance discharge and prevent delay, through early and effective planning, limiting hospital stays to what is clinically and functionally essential, and getting patients home at the earliest, safest opportunity. These can be distilled down to three basic elements.
1. Prepare and plan for discharge with patients, from admission;
2. Prioritise and protect time to plan as an extended team;
3. Adopting a ‘Home First’ ethos.
What is the Home First ethos?
The Home First ethos ensures that people can be cared for at home (or as close to home as possible), prevents avoidable admissions to hospital and, where hospital admission is necessary, supports timely discharge.
Is there evidence of DwD working elsewhere?
By applying the principles, by making small changes in how things are done, and building on a three-point foundation, the results have been extraordinary.
Several ‘pathfinder’ Boards (where the approach has been tested) have reported a reduction in delayed days and length of stay, but equally importantly, an increase in the number of patients who left their care without having experienced any delay. The application in one health board has seem delayed days reduced by 60 per cent in one hospital where the approach was piloted in 2019. More recent work as part of recovery in another site saw a reduction in delayed days of over 50 per cent in four weeks.
For health and care staff what supports are in place to help them adopt DwD?
For health and care staff, we also know times have been challenging. There is not been much time to catch breath and the prospect of change may seem exhausting. We cannot make the challenges of delay go away – but by working together we can exert control and influence over it.
There are several supports in place to support the implementation of the DwD programme.
These are:
- Self-assessment tool – a process of change often starts with honest reflection, what is working well, identifying gaps and building on them;
- Access to hands-on support and expertise from our improvement advisors and programme leads;
- Webinars for more information and a learning network to exchange ideas talk through challenges with peers in a safe environment.
Where can I get further information about DwD and supports available?
You can watch the animations explaining what DwD is and a short clip highlighting where practitioners can find more support.
You can also email nss.dwdteam@nhs.scot
