Hospital Discharge Service Guidance
Intermediate Care and Transitional Care
Duygu Sezgin et. al. (April 2020) "Defining the characteristics of intermediate care models including transitional care: an international Delphi study" Aging Clinical and Experimental Research https://doi.org/10.1007/s40520-020-01579-z
The study was on behalf of European Union Advantage Joint Action Work Package 7 partners in collaboration with the International Foundation for Integrated Care Special Interest Group on Intermediate Care. Participating authors in the study included Helen Tucker, John Young, Claire Holditch and Anne Hendry.
The Delphi study identified key defining features of intermediate care and led to an agreement on a definition of intermediate care.
"Intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care."
The study also concluded that models of intermediate and transitional care "are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination."
This collaborative study has led to an improved understanding of intermediate care and will support comparisons and evaluations.
To read the study please click this link
Duygu Sezgin, Rónán O’Caoimh, Mark R. O’Donovan, Mohamed A. Salem, Siobhán Kennelly, Luz Lopez Samaniego, Cristina Arnal Carda, Rafael Rodriguez Acuña, Marco Inzitari, Teija Hammar, Claire Holditch, Janet Prvu Bettger, Martin Vernon, Áine Carroll, Felix Gradinger, Gaston Perman, MartinWilson, Antoine Vella, Antonio Cherubini, Helen Tucker, Maria Pia Fantini, Graziano Onder, Regina Roller-Wirnsberger, Luis Miguel Gutiérrez-Robledo, Matteo Cesari, Paula Bertoluci, Magdalena Kieliszek, Wilma van der Vlegel-Brouwer, Michelle Nelson, Leocadio Rodríguez Mañas, Eleftheria Antoniadou, François Barriere, Sebastian Lindblom, Grace Park, Isidoro Pérez, Dolores Alguacil, Douglas Lowdon, Maria Eugenia Alkiza, Cristina Alonso Bouzon, John Young, Ana Carriazo, Aaron Liew, Anne Hendry
NICE guideline 94
Chapter 12. Alternatives to hospital care Emergency and acute medical care in over 16s: service delivery and organisation
The guidance defines community hospital schemes for alternatives to acute hospital care.
"Community hospital schemes usually provide acute hospital ward type care, but generally under the management of GPs rather than consultants. Community hospital schemes can provide nursing, rehabilitation or step up/down type care and are generally aimed at those users who require a high level of supervision or the administration of medicines or interventions which would not be suitable for a nursing home or a users’ own home setting."
The guidance draws on published papers by Young, Garasen, O'Reilly etc and is a very useful resource.
Link to the Report
NHS Long Term Plan
The NHS Long Term Plan (LTP) published in January 2019 focuses on making sure that everyone gets the best start in life, that people with major health problems have world-class care, and that older people are supported to age well. The LTP wants to break down barriers between primary and community care, with primary care networks created in localities which form part of an Integrated Care System (ICS). Community hospitals are well placed to be an integral part of an integrated system, with new evidence of integrated working. The LTP aims to make the NHS a better place to work, with proposals to support the workforce. This includes expanding the use of volunteers through volunteer programmes. Initiatives in community hospitals may help to inform this ambition.
The LTP announces an investment in locally-based services that form part of "out of hospital" care. The CHA welcomes this investment, and hopes that the role of community hospitals in offering integrated intermediate care is recognised in creating community capacity and making a significant contribution to the reduction in the utilisation of acute services.
To read more follow the link
The Practice: A case study of a vanguard pilot site
"The Practice" is a branch practice to seven local GP practices and is based in a community hospital. This study concludes that establishing "the practice" at Lymington Hospital "demonstrates an alternative model of primary care delivery.... It has brought together primary care professionals, community care professionals, secondary care professionals and the CCG to work to a common purpose of providing better local care for the local population."
Johnny Lyon-Maris and Samantha Scallan GP Education Unit, Southampton, New Forest and Jersey
To read more follow the link
NICE Guidance on Intermediate Care including Reablement
This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care. It is highly relevant for community hospital providers and staff, as well as commissioners. To access the report please follow the link
Lynne Mann, (2016)"Delayed discharges within community hospitals: A qualitative study investigating the perspectives of frontline health and social care professionals", Journal of Integrated Care, Vol. 24 Iss: 5/6, pp.260 - 270
To access the article, please follow the link
Transfer and readmission of patients between acute and community hospitals: a retrospective review
Endacott et al May 2015 Quality in Primary Care 23(1) 46-50
To access the article please follow the link
A fascinating paper has been published by one of the research teams on what we can learn from community hospital provision internationally.
The paper by the RAND team draws on learning from 75 papers from 10 countries, and identifies the diversity of services, and also the key role that community hospitals have in integration.
A recently published study from Norway has reviewed community hospitals and concluded that they make a valuable contribution to local health systems. Read more
“Our findings suggest that this type of intermediate care is a viable option in an effort to alleviate the burden on hospitals by reducing the acute secondary care admission volume.”
Swanson, J and Hagan, T (2016) “Reinventing the community hospital: a retrospective population-based cohort study of a natural experiment using register data” BMJ Open 2016;6:e012892 doi:10.1136/bmjopen-2016-012892 Health policy
Local community hospitals offer a safe and viable option to acute hospital admission according to a new report out by researchers at the University of Bristol. The researchers examined evidence on five types of community-based care. One of the studies they considered reported fewer readmissions and less community care needed following a community hospital intervention compared to acute hospital care.
Read more here
BMJ 2016; 354 (Published 19 July 2016)
The letter calls for a halt to the indiscriminate reductions of services and closures in community hospitals until the outcome of current research studies are available. The article also refers to countries such as Italy and Norway, where they have a clear strategy to develop community hospitals and intermediate care. The letter was “letter of the week” in the BMJ, and it is hoped that it raises the profile of community hospitals and encourages a debate.
Read more here
The CHA maintains a database of literature on Community hospitals and associated services. The CHA has prepared two resource packs of published papers, one for the UK and one international. These resource packs offer an introduction to the literature, with a selection of references.
Forged in the Fire of Adversity
by David Wood, CEO of Attend. The book can be downloaded here