Quality statement 2: Starting bed-based intermediate care

Quality statement

Adults accepted for bed-based intermediate care start the service within 2 days of referral.

Rationale

Delays in starting bed-based intermediate care can increase the risk of further deterioration in the person's condition and lead to reduced independence. If the move to bed-based intermediate care from hospital or the community takes longer than 2 days it is likely to be less successful and could lead to admissions to hospital or residential care that could have been avoided.

Quality measures

Structure

Evidence of local arrangements to ensure that bed-based intermediate care can be started within 2 days of referral.

Data source: Local data collection, for example, referral pathways from hospital and the community and service protocols.

Process

a) Proportion of adults accepted for bed-based intermediate care from hospital who start the service within 2 days of referral.

Numerator – the number in the denominator who start the service within 2 days of referral.

Denominator – the number of adults accepted for bed-based intermediate care from hospital.

Data source: Local data collection, for example, audit of electronic records. The NHS Benchmarking Network National Audit of Intermediate Care includes data on waiting times for bed-based intermediate care.

b) Proportion of adults accepted for bed-based intermediate care from the community who start the service within 2 days of referral.

Numerator – the number in the denominator who start the service within 2 days of referral.

Denominator – the number of adults accepted for bed-based intermediate care from the community.

Data source: Local data collection, for example, audit of electronic records. The NHS Benchmarking Network National Audit of Intermediate Care includes data on waiting times for bed-based intermediate care.

c) Proportion of referrals for bed-based intermediate care that were not accepted due to insufficient capacity.

Numerator – the number in the denominator that were not accepted due to insufficient capacity.

Denominator – the number of referrals for bed-based intermediate care.

Data source: Local data collection, for example, audit of referral records. The NHS Benchmarking Network National Audit of Intermediate Care includes data on reasons for not being accepted onto the scheme including a lack of capacity.

Outcome

a) Rate of unplanned hospital admissions for chronic ambulatory care sensitive conditions.

Data source: Data on unplanned hospital admissions for chronic ambulatory care sensitive conditions are available from NHS Digital's Clinical Indicators as part of the NHS outcomes framework – indicator 2.3i.

b) Rate of delayed transfer of care from hospital for adults.

Data source: Data on average number of delayed transfers of care from hospital per 100,000 population are available from NHS Digital's Clinical Indicators as part of the adult social care outcomes framework – indicator 2c.

c) Proportion of discharges from bed-based intermediate care to acute hospital or residential care.

Data source: Local data collection, for example, audit of electronic records. The NHS Benchmarking Network National Audit of Intermediate Care includes destination on discharge for adults admitted to bed-based intermediate care.

d) Proportion of people who were still at home 91 days after discharge from hospital into reablement or rehabilitation services.

Data source: Local data collection, for example, audit of case records. Data on the proportion of older people (aged 65 and over) who, after a period of reablement or rehabilitation, maintain their independence by remaining or returning to their home or previous residence 91 days after leaving hospital are available from NHS Digital's Clinical Indicators as part of the NHS outcomes framework – indicator 3.6.i.

What the quality statement means for different audiences

Service providers (such as hospitals, community providers, care homes and not-for-profit social enterprises) have processes in place to ensure that adults start bed-based intermediate care within 2 days of referral from hospital or the community. This may require a coordinated approach to manage demand for intermediate care across local hospital and intermediate care services, for example, through a single point of access for referrals.

Health and social care practitioners (such as nurses and allied health professionals) ensure that adults accepted for bed-based intermediate care start the service within 2 days of referral from hospital or the community.

Commissioners (such as clinical commissioning groups and local authorities) commission bed-based intermediate care services with sufficient capacity to ensure that adults can start the service within 2 days of referral from hospital or the community. Commissioners ensure that they manage demand for intermediate care services efficiently, for example, through a single point of access for referrals. Commissioners monitor waiting times for bed-based intermediate care.

Adults who are having bed-based intermediate care to help their recovery are able to start this within 2 days of being referred. This will help them to regain their independence as soon as possible.

Source guidance

Intermediate care including reablement (2017) NICE guideline NG74, recommendation 1.5.3.

Definitions of terms used in this quality statement

Bed-based intermediate care

Assessment and interventions provided in a bed-based setting, such as an acute hospital, community hospital, residential care home, nursing home, stand-alone intermediate care facility, independent sector facility, local authority facility or other bed-based setting. For most people, interventions last up to 6 weeks. Services are usually delivered by healthcare professionals or care staff (in care homes) as part of a multidisciplinary team.

[NICE's guideline on intermediate care including reablement, terms used in this guideline section]

Within 2 days of referral

Within 48 hours of receipt of the referral.

[NICE's guideline on intermediate care including reablement, recommendation 1.5.3]

Equality and diversity considerations

Providers of bed-based intermediate care should not exclude people based on whether they have a particular condition, such as dementia, or live in particular circumstances, such as prison, residential care or temporary accommodation.