Abstract
Background: In October 2023 we were approached by our local Integrated Care Board to host 2 slow stream beds at our 33 general bedded inpatient rehabilitation unit as a pilot. Our commissioned standard length of stay is 14-21 days, however it was felt within our locality there was a need for an alternative longer length of stay inpatient pathway for more complex patients.
Approach: We involved our local acute hospitals, local discharge hubs, social services, our clinicians, and our local integrated care board in the implementation of this pathway. This consisted of staff surveys as well as meetings. Following initial consultation, we implemented the pathway relying on referrals from the acute hospitals and discharge hubs. During the pilot we gathered feedback from clinical staff involved with the pilot, social workers, and patients themselves. This comprised of staff surveys, team discussions, case studies and patient feedback, stories, and interviews. Patients input on the design of the pathway helped us shape and change the pathway in different ways. For example, following feedback we created alternative methods to accept patients onto this pathway. We identified patients already on our standard pathway, and converted them onto the slow stream pathway. Based on feedback we allowed our clinical screener, who screens all referrals to the unit, to identify appropriate patients. Staff satisfaction also increased during this pilot, due to staff being able to utilise their skills and being able to see bigger functional improvements in patients. Following the initial 1 year pilot we engaged with all stakeholders where we agreed to continue this pathway.
Results: We had 12 patients on this pathway since October 2023. 9 have been discharged and three are currently on the pathway, with a further 4 currently on a waiting list. The average length of stay of these patients is currently 6-7 weeks. We realised an annual saving based on the 9 patients discharged (as opposed to if they did not come on this pathway) of approx. £500,000. All our patients achieved functional gains, increased independence, increased quality of life and were able to return home on discharge. 100% of patients returned home and 100% of patients remained at home 30 days following discharge. We used the Functional Independence measure, staff and patient feedback, patient stories, 30 day re-admission rates, discharge destination and follow up care needs to measure the impact of the pathway.
Implications: This pathway shows the need in our locality in Northwest London for a slow stream inpatient rehab pathway. We have presented this to senior management and our local integrated care board have been able to increase our beds on this pathway from 2 to 4 (doubling our offer) as of November 2024. We are aware of another local rehab unit that is now piloting a slow stream pathway with 3 available beds, that are all utilised. We hope to continue to be flexible with our approach and ideally have a service with a multidisciplinary led approach to estimated discharge dates.