INTERMEDIATE CARE Dr Eugene Mooney Introduction • Intermediate Care refers to “care provided to individuals outside the acute setting” • Intermediate Care is a “range of integrated services to prevent unnecessary admission to hospital, promote faster recovery from illness, support timely discharge, and maximise independent living” Discussion • Demand for information; • Purpose of the collection; • Development of the collection; and, • The Way Forward. Demand for Information • DHSSPS requires information to monitor intermediate care services on a regional basis to ensure that services are; – Representative of a patient-centredness approach; – Flexible to individual needs; – Reduce unnecessary admissions to hospital; – Facilitating early discharge; – Maximising independence of individuals; – Provided within time scales; and, – Not seen as “Indeterminate Care (Dustbin Service)”. Purpose of Collection • Evaluate Intermediate Care Schemes, i.e. possible outcome measures such as services received on entry and services received on discharge from Intermediate care; • Track individuals, i.e. identify re-admissions to hospitals, other intermediate care schemes etc; and, • Effect of Intermediate Care, i.e. if IC had not been available the patient would have spent X number of days in Hospital Development of the Collection • Literature Review, i.e. has there been any similar type projects carried out; • Information Required, i.e. specific data items required; • Defining the Process, i.e. how are clients cared for in intermediate care to allow us to track all clients; • Current Information Systems, i.e. consultation to identify current monitoring arrangements within Trusts; and, Information Required • Personal Details, i.e. gender, date of birth, postcode; • Referral Details, i.e. source of referral, reason for referral; • Intermediate Care Service, i.e. type of scheme, key dates such as start of IC assessment, assessment determination; • Services received on Discharge from Intermediate Care, i.e. identify delays in provision of continuing care needs Personal Details • Client Level Information, enable detailed tracking of clients; • Personal Identifier, i.e. SOSCARE no, Health & Social Care Number to avoid double counting and enable tracking; • Additional information on personal characteristics, i.e. gender, date of birth, postcode; and, • Source of Referral, i.e. from Acute services or Community services detailing service currently being provided. Personal Details Referral Details • Source of Referral, acute / community, detailing current services received; • Date of Referral to ICS, i.e. to monitor delays in processing referrals by ICS; • Identify Referrals not Accepted, i.e. reason not accepted, Referral Details Intermediate Care Services Information • Date of Start of Assessment within ICS, i.e. begin of assessment of continuing care needs and entry to intermediate care; • Package of Care on Acceptance to ICS, i.e. OT, Physio, Rehabilitation, Nursing Care, etc; • Date of Assessment of Long Term Care Needs Completed, i.e. individuals continuing care needs identified; • Clients Assessed Needs, i.e. residential care, reduced domiciliary care package etc. Intermediate Care Services Information • Date Discharged from ICS, i.e. when did the client leave the IC setting; • Package of Care on Discharge from ICS, i.e. OT, Rehabilitation, Nursing Care, Physio, etc. This will be used to identify any waiting lists in relation to the clients assessed need; • If Discharged to Hospital, i.e. reason admitted / re-admitted to hospital; Intermediate Care Details Intermediate Care Details Possible Problems • Need to Develop IT and Communications Systems, i.e. when did the client leave the IC setting; • Rationalisation of Schemes in NI, i.e. universal naming conventions for schemes; • Clear Definition of Intermediate Care, i.e. ensure all Trusts are counting on a like for like basis; and, • Access a Single Patient Record. Possible Outcome Measures • Bed Days Saved, i.e. by providing Intermediate Care X number of bed days were saved; • Quality of Life Outcomes, i.e. sense of personal identity, social integration, social contact, sense of autonomy; and, • Re-admission to hospital or other intermediate care scheme; • Level of Service provision on discharge, i.e. less intensive service required by client is more cost effective. The Way Forward • Further Consultation with Trusts, i.e. currently there are reporting mechanisms in place but these differ between HSS Trusts and HSS Boards, whilst we are focused on a regional perspective; • User Experience Survey?; • Impact of RPA; • Development of IT Systems to Manage Information, i.e. current information systems are not easily adaptable, lack of consistent systems for recording and of agreed definitions in HSS Trusts; and, • Access a Single Patient Record.
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