COUNCILLORS  have been looking for ways patients could be dealt with more quickly in hospital Accident and Emergency departments and how in-patients who are ready to go home can be discharged faster.

Data shows hospital beds were ‘blocked’ for thousands of ‘bed days’ in the past year – meaning patients needing treatment couldn’t be admitted.

And there are also concerns that patients are having to wait too long at A&E  – with even ambulances reporting that they have had to wait up to 45 minutes to drop off patients.

Now councillors at Hertfordshire County Council have held a special meeing to look at what’s being done to address the problems and how it could be improved further.

Before coming up with their recommendations councillors on the ‘patient flow topic group’ heard evidence from a number of groups.

They included the East of England Ambulance Service Trust (EEAST), the West Hertfordshire Hospitals NHS Trust, the East and North Hertfordshire NHS Trust, commissioning CCGs and the Hertfordshire Community Trust.

Staff from EEAST told the meeting of the steps they already take to relieve the pressure on hospital emergency departments.

They reported that they receive around 3200 daily 999 calls, which can rise to 4000. On Christmas Eve they received 4800.

But, they say, call handlers will now routinely redirect as many as 40-50 per cent of callers to pharmacies, GPS and other services, as part of the ‘hear and treat’ process. So, as few as half of 999 callers actually see an ambulance.

Ambulance staff then treat as many patients as they can in their homes, with only those patients who need specialised treatment being taken to hospital.

Measures are in place to support residents in care homes to prevent needless trips to hospital too.  And there’s  a dedicated ‘early intervention vehicle’ for patients who are elderly or frail.

Dealing with as many patients away from the hospital, they say, is all part of speeding up emergency services in hospitals for those that really need them.

“We see our primary role as identifying patients who are really sick and getting them into hospital as quickly as possible,” said EEAST sector head Simon King.

Ambulances have had to wait up to 45 minutes to drop off patients at local Emergency Departments, but they say data shows that has now reduced to 20 minutes. And they put this down, in part, to better processes and escalation procedures.

As well as measures to reduce the number of patients needing emergency treatment at hospital, councillors also heard about the drive to get in-patients back home again as quickly as possible, to avoid so-called ‘bed-blocking’.

Beds are said to be ‘blocked’ if an in-patient continues to be in a bed when they no longer have a clinical need to remain. The health trusts refer to this as a ‘delayed transfer of care’, which is measured in days.

Latest data shows that between April 2017 and February 2018,  Herts Valleys CCG’s area – which includes Watford General Hospital – recorded 17,975 days of delay.

The area covered by the East and North Hertfordshire CCG – which includes the Lister Hospital, in Stevenage – recorded 7488 days of delay.

The most common cause of delay is shortage of homecare capacity and the pressure on so-called ‘step down’ and ‘intermediate’ beds.

But some patients find they can’t leave hospital on the day because of a lack of hospital transport or because their medication isn’t ready in time.

Both hospitals now have Integrated Discharge Teams, who track the diagnosis, treatment and recovery of patients.

And councillors heard about the work they undertake to cut delays when patients were ready to leave hospital.

Heidi Hall, head of integrated discharge (east) for the East and North Hertfordshire NHS  Trust, said planning for discharge at the Lister Hospital started almost as soon as a patient arrived.

Every patient is allocated an ‘estimated discharge date’.  And potentially complex patients will then be monitored throughout their stay, to ensure discharge isn’t delayed by the need for additional assessments or information.

“We have to change the culture to make sure we plan discharge as early as possible,” said. Ms Hall.

Among the initiatives and practices used at both hospitals, staff from the West Hertfordshire Hospitals NHS Trust also highlighted the Red2Green monitoring tool,  which is used in both Trusts and which can speed up discharge.

A ‘red’ day is when a patient receives little or no acute care. A ‘green’ day is when a patient receives care that can only be in an acute hospital bed.

“Red2Green is about making sure patients have something positive done to them every day,” said Debbie Foster, from the West Hertfordshire Hospitals Hospital Trust.

“It has had some success so far and we can see some demonstrable change in wards that have implemented it.”

The Red2Green is just one of a number of initiatives highlighted to the scrutiny panel during the day-long session.

The scrutiny group also considered the shortage of available care provision in the community  – particularly in the west of the county.

And they considerd what could be done to attract more people into the caring profession.

At the end of the day, members of the ‘patient flow topic group’ made a number of recommendations.

They recommended that the ‘early intervention vehicle’ model is replicated across the whole of the county.  And they suggested CCGs map GP referrals to A&E.

They said the trusts should continue to share good practice and information and any improvements made to patient flow. And they say that every hospital patient should have an estimated discharge date within 24 hours of being admitted.

They believe enhanced community therapies could be used to speed up discharge, as well as preventing hospital admission in the first place.

And they would like the hospital trusts to actively investigate e-prescribing, as a means to make sure discharge wasn’t delayed because patients were waiting for a prescription.

The findings of the ‘patient flow topic group’ will be published next month. (June)