Discharge to assess: transforming the discharge process of frail older patients.

The 2012 Royal College of Physicians report is clear that 'decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their own service - are organised'. This paper describes a service redesign in which we have gained learning and experience in two areas. Firstly, a description of measured improvement by the innovation of redesigning the traditional hospital-based assessment of frail older patients' home support needs (assess to discharge) into their own home and meeting those needs in real time (discharge to assess).

Frailsafe: from conception to national breakthrough collaborative.

The number of people aged over 60 years worldwide is projected to rise from 605 million in 2000 to almost 2 billion by 2050, while those over 80 years will quadruple to 395 million. Two-thirds of UK acute hospital admissions are over 65, the highest consultation rate in general practice is in those aged 85-89 and the average age of elective surgical patients is increasing. Adjusting medical systems to meet the demographic imperative has been recognised by the World Health Organisation to be the next global healthcare priority and is a key feature of discussions on policy, health services structures, workforce reconfiguration and frontline care delivery.

Introducing quality improvement as an intrinsic part of healthcare.

Healthcare systems worldwide face the challenge of recognising and improving safety, timeliness, quality and productivity. The authors describe how the COM-B model, developed by Michie et al in 2011 to explain and change criminal behaviour, is useful in identifying what skills and capabilities healthcare providers require to improve their systems. These skills include the intellectual capability to understand, design and improve healthcare processes; the opportunity to do this in their daily work; the motivation to do this - in particular recognising the reasons not to change; and finally unlearning the behaviours based on historical system beliefs that are now invalid.

Does process flow make a difference to mortality and cost? An observational study.

Purpose: The purpose of the paper is to investigate the potential relationships between emergency-care flow, patient mortality and healthcare costs using a patient-flow model.

Design/methodology/approach: The researchers used performance data from one UK NHS trust collected over three years to identify periods where patient flow was compromised. The delays' root causes in the entire emergency care system were investigated.

Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources.

Background: hospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients.

Objective: we undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources.