Discharge to assess (D2A) is about funding and supporting people to leave hospital, when safe and appropriate to do so, and continuing their care and assessment out of hospital. Patients can then be assessed for their longer-term needs in the right place. iNetwork has recently held a couple of sessions about Discharge to Assess (D2A) and this blog takes a look at what we have heard and learned about the experience of implementing the D2A process so far.
Oldham’s D2A Journey
On Tuesday 12th October, iNetwork held an event to look at how Oldham is approaching the completion of the Greater Manchester D2A referral. At this session, we invited speakers Liz Lyons, Integrating Digital Care Programme Manager for Unity Partnership (wholly owned by Oldham Council) and Jon Taylor, Enterprise Architect at Unity Partnership to share their experience of digitalising the D2A process. They shared an insight into how Oldham’s integrated digital journey has led to the digitalisation of the Greater Manchester D2A template for Oldham.
In 2021 supported by Oldham CCG, Unity Partnership alongside Strategic Partners Airelogic embarked on a digital journey to increase the localities ability to integrate and share health and care data across multiple organisations. It was through discovery and understanding of the current issues faced within the locality that the team identified a selection of information sharing and digital functionality problem statements.
This programme also identified four design principles which would help select which problem statements they had the ability to overcome. These principles are:
- – The information exists in a standard electronic format
- – The information is accessible
- – The information is shareable
- – The information has future scope to be interactive across different services.
In the D2A ‘as is’ process it was identified that information for this process did not exist in a standard electronic format and therefore digitalisation must occur to enable integration. The current D2A process required input from a range of professionals and the current process was time consuming and utilised unnecessary capacity in its current form, therefore D2A was selected as the MVP (Minimum Viable Product) for this programme. The problems identified with the current D2A process within Oldham were:
- – Transportation: of the paper form. This has to be printed, completed, scanned in by the ward clerk and then attached to an email and then sent.
- – Inventory: there is a potential risk of a backlog in forms awaiting completion due to lack of information available on the ward.
- – Motion: ward staff are often required to chase up notes or information which is not available when completing the D2A form which creates a delay.
- – Waiting: there are a lot of waiting times such as, waiting for information on the ward, waiting for test results, waiting for medication, waiting for input from another professional or waiting for equipment to come free.
- – Over Processing: full completion of the form is often done in the Oldham Discharge Hub rather than on the ward, this can cause duplication.
- – Defects: there is a high risk of rework in the referral process if inaccurate information is sent to the Oldham Discharge Hub.
- – Skills: There is variation in knowledge on the current D2A requirements, purpose and processes.
These issues meant that the process was often fragmented, paper based and information collated in wards was incomplete. This created large amounts of duplication. The speakers shared how they focused on identifying D2A as a problem area that could be overcome by enabling digital integration and interoperability.
To address these issues, the Oldham team worked alongside a dedicated business change lead; engaged with the staff responsible for completing and receiving the forms; and sought clinical input to co-design the digital D2A process with users in mind. In addition, the Greater Manchester approved form was adopted, buy-in from leadership was secured, and local technical initiatives were utilised and explored. The focus was on digitalisation first, then integration.
Oldham’s D2A form has been created alongside Airelogic, utilising an application called Forms4Health. The form and user interface is hosted by Unity Partnership and accessed directly by the staff on the wards who are dealing with patient discharge. The form links directly to NHS mail so it can be delivered directly to Oldam’s Discharge Hub. The form offers a patient search function to allow for the form to be saved and resumed at a later date. The links to the Acute Patient Administration system automatically pre-populate demographic details on the form and many fields have been made mandatory to avoid missing out information. Clinicians can navigate through the form in any sequence and save and resume at their own convenience. Discovery feedback from clinicians and users led to the COVID19 vaccination status and a frailty score being added to the Oldham digitised form.
Liz and Jon shared learning from their journey and highlighted that it was key to have a good leader on the frontline who was engaged with the project from beginning to the end. With hindsight this project may have worked even better if they had a dedicated IT project manager in each organisation that could identify and coordinate delivery teams. Ensuring that dedicated information governance leads are involved from the start of any development proved invaluable when working in an integrated approach; this was a key lesson learned.
Going forward for Oldham and their D2A journey, they have started the testing process for the integrated version and no longer have unpopulated D2A forms. The development of the digital D2A system has created a reusable capability which can be used to develop multi-disciplinary shared care planning. It links to different organisations’ Azure active directories, pulling information directly from care systems to avoid duplication. The save and resume function and patient search allows multiple professionals to input and collaborate on one version of the D2A form. This could lead to further developments in other areas to allow for multi-disciplinary teams to work in collaboration on care plans and referrals.
The D2A Journey Elsewhere
Many organisations are now beginning their own D2A journey’s and at Trafford Council they are in the very early stages of creating a digitalised D2A process as their current system only provides a semi-live view and causes issues when they are trying to manipulate or copy the data. Digitalising their process will support them in having access to the data and eliminate any risk of admin errors when copying or manipulating the data.
Rotherham Council adopted the national D2A model in March 2020 and already has an integrated discharge team. They are part way in digitalising the process and their current health record is made up of shared record acute data and primary care, this provides an insight into the data however it is not in real time and is not completely up to date information. Once they have managed their information governance permissions they can complete the digitalisation of the D2A process and aim to provide real time up to date data.
Other products to support the D2A journey have been developed. For example, Hospital to Home (H2H) was closely co-designed with five councils via a rapid ‘living’ discovery, design and development process. The H2H system can offer case management and tracking functionality allowing users from multiple organisations to create/track/update D2A cases. This product was showcased at the iNetwork Annual Conference – Driving with Data: People, Place & Prosperity on November 18 2021 by Stephen Girling, Product Owner, at Tech in Care. iNetwork members can view the full presentation from the session here.
For More information
For any further information on Oldham’s D2A project, please contact Liz Lyons
For any further information on the Hospital to Home product, please contact Stephen Girling