11 May 2016

In the bag - making moving between hospital and social care better

The introduction of a 'red bag' Hospital Transfer Pathway has helped to improve and speed up the transfer between hospital and care home settings.

Sutton Homes of Care Vanguard Programme developed the simple and novel approach to follow NICE guidance on the transition between hospital and care home settings

When a resident becomes acutely unwell and needs to be taken to hospital, this new pathway ensures they are transferred with a set of standardised paperwork which details all necessary health and social care information about that resident to support staff in providing the right care. This is contained in a “red bag” which also holds their medicines and personal belongings. Following this pathway has improved care and ironed out potential problems for patients and their carers that can cause confusion and delay.

Delays in the discharge of patients place a huge burden on the NHS. Figures show that more than a million hospital days were lost due to delayed discharges in 2015. In 2012-13, more than a million people were readmitted to hospital as an emergency within 30 days of discharge. This cost the NHS £2.4 billion.

Through collaborative working, the partners of the Sutton Homes of Care Vanguard programme identified some issues in the transfer of residents to hospital, and agreed a standardised handover process would lead to better quality of care in its area.

Ambulance crews were being delayed while care home staff put paperwork together. Medical teams did not have sufficient information on the resident’s clinical needs and would have to make frequent calls to care homes to get information on residents. Personal belongings were also not being transferred or could be lost while residents were in hospital.

Furthermore, many residents were arriving back at care homes without the right medication, treatment information, or changes to their care plans.

Improved communication, speedier transfer times

To tackle this, the Sutton Vanguard introduced the Hospital Transfer Pathway, also know as the ‘Red Bag’ initiative. The bag and its contents stays with the resident throughout their stay at hospital and is returned home with them on discharge. 

Through standardising the paperwork all staff who provide care for the resident will have the information required about their general health. When they are discharged, a ward nurse ensures all the paperwork is updated and sent back with the resident.

So far, the Hospital Transfer Pathway has led to:

  • improvement in communication and relationships between hospital and care homes
  • fewer phone calls and follow ups made by the hospital staff to the Care Homes looking for health information about the resident
  • smoother admission and discharge processes
  • better person-centred care for the residents

Future evaluation may also demonstrate a reduction in length of stay but it is too early to confirm this.

A ‘strikingly simple’ method of improving care

Viccie Nelson, Care Home Director at NHS Sutton CCG, said: “Since we’ve carried out the red bag initiative, we’ve had positive feedback from both care home staff and residents’ families. It has improved communication, speeded up transfer, and reduced the number of calls that the hospital makes to the home from around 5 or 6 for each resident to just 1.

“At Sutton we’ve focused on improving the quality of care for those in care homes. NICE guidelines have helped this project by to showcasing best practice and providing neutral territory for us as an organisation to agree on good quality care.”

Listen to Viccie Nelson and Christine Harger, Quality Assurance Manager with Sutton Homes of Care Vanguard Programme, talk more about the project.

Professor Gillian Leng, Deputy Chief Executive of NICE, and Director of Health and Social Care, added: “It is important that people experience a smooth and timely transition from hospital back to their care home or own home. This can help improve a person’s experience of care and their quality of life. It also eases pressure on hospitals, and avoids people becoming caught in a ‘revolving door of care’ when they get readmitted to hospital.

“Sutton’s red bag approach is an innovative way tackling these problems, yet is striking in its simplicity. We wish them success in their project, and look forward to seeing further results as it progresses.”

Sutton Homes of Care is one of four NHS vanguards that NICE is sponsoring. Listen to Chris Elliot, a Sutton GP and Chief Clinical Officer at NHS Sutton CCG, talk more about how he feels Sutton’s vanguard status will help improve care.

Sutton’s red bag approach is an innovative way of ensuring a smooth transition from hospital to care home, yet it is striking in its simplicity.

Professor Gillian Leng, Deputy Chief Executive of NICE, and Director of Health and Social Care