Setting up a therapy-led community ward

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A case study from Nottingham University Hospitals NHS Trust, describing how the use of a community ward has improved discharge rates, reduced length of stay and shifted ward culture.

What was the problem?

The trust had many older patients in its medicine division remaining in hospital longer than necessary, usually due to delays in transferring their care to community health or social services.

As a result, they risked losing mobility and their ability to do everyday tasks such as bathing and dressing.

What was the solution?

Care

Setting up a community ward, B49, to provide more appropriate care from a therapy-led team focusing on reablement and speeding up discharge through board rounds, internal escalation and links to community and social care services.

The number of auxiliary posts on B49 was increased relative to registered nursing posts to reflect the reablement approach. Patients remained under the care of the consultant team from the original ward in case they return there due to medical deterioration.

A rotating trust-grade doctor was assigned to the ward to update medicines and discharge summaries, and to review medically unwell patients.

Management

The ward manager - an allied health professional - used the trust's bed management system to select patients according to agreed criteria, while the division's bed managers also identified appropriate patients.

New and positive relationships were established with ward sisters and matrons.

The B49 team is committed to the #EndPJparalysis initiative, emphasising the importance of getting out of bed, being dressed and accessing the dining room and bathrooms.

What were the results?

  • The mean average of discharge rates increased by 50%.
  • Overall ward length of stay was reduced by 30%¬†(from 13 days to nine).
  • The reablement approach has begun to shape the ward culture.

What were the learning points?

  • Collaborative cross-professional working makes possible new ways of working and helped create a new ward model.
  • AHPs can be ward managers.
  • The initiative provides realistic opportunities to shape patient and family expectations of acute NHS services and bed usage.

Next steps

Other divisions in the trust have noted that having a ward leader who is not a nurse can succeed.

Other trusts have expressed interest in establishing similar models.

Want to know more?

Please contact:

Debaleena McGrogan, occupational therapy advanced practitioner for older people: Debaleena.McGrogan@nuh.nhs.uk

Joanna Peet, B49 community ward manager: Joanna.Peet@nuh.nhs.uk

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