Newham Mental Health: Reducing Use of Private Admission Beds
6th September 2024
By Lucy Brewer (Improvement Advisor), Brunot Ngangue-Ekwe, Ola Kurdelska and Tim Opoku (Inpatient Discharge Team), Dave Baillie (Associate Clinical Director – Inpatients)
Teams have been under extremely significant pressure regarding flow through the system. This is due to several issues, such as more complex housing and social factors, and has led to fewer availability of local admission beds. At the start of 2024, there was a rapid increase in the number of patients needing to be admitted to private beds. The private facilities, unfamiliar with the patients and lacking community connections, led to patients being on these wards for longer. One of the interventions was to pilot an enhanced discharge team to focus on patients admitted to private beds (fig. 1).
Fig 1. Theory of change outlining factors that need to be addressed and the change ideas to improve flow in the system.
Intervention: From March 2024, a dedicated multidisciplinary team have been working in collaboration with the senior directorate leads to ensure patients receive the right care, at the right time, in the right place. This intervention comprised of several factors, detailed below:
Pre-Admission:
The team been clarifying recourse to public funds status, benefits entitlement, housing needs prior to transferring patients to private care.
Where possible, patients were admitted to the triage wards prior to transfer to private units. This effective triage process has enabled the team to understand the patient needs prior to admission to a private bed. It also facilitated short crisis admissions, preventing a potentially lengthier admission in a private facility.
Enhanced Communication:
The team attended ward rounds for patients in private care and would also attend in person to review patients.
Responsible for maintaining and updating records of patients in private beds.
Weekly or fortnightly communication with private providers.
Effective Discharge Planning:
Assessing accommodation and coordinating with community follow-up teams.
Liaising with other services (e.g. housing, social care) to expedite discharges.
The team brought back patients for a pre-discharge review to allow greater confidence for clinicians in private facilities to discharge patients.
Support from Multidisciplinary Team (MDT):
Weekly and ad hoc meetings with the inpatient Associate Clinical Director (ACD) and Mobile One Team Consultant to discuss cases and leverage their expertise.
Involving the Clinical Director and Borough Director in complex cases, particularly those related to social and AMHP services.
Outcome: Over the past few months, the team have seen a sustained reduction in the number of patients admitted in private beds, and for the past couple of weeks had one or no patients in a private bed (fig. 2). The team continues to prioritize quality care and making decisions which are in the best interests of the patient. A key element underpinning this work is the importance of knowing the patients and having the clinical confidence to make decisions.
Fig 2. Statistical Process Control (SPC) Chart showing the number of patients from Newham in private beds, each week.
Next steps: The discharge team are now focusing on patients admitted to Newham. They are currently supporting Crystal Ward to enhance discharge planning. At present this involves reviewing patient lists to identify / address needs and testing a discharge facilitation checklist. The Newham management teams are also testing other change ideas, to address other parts of the system, with the aim to see an overall improvement in flow.