In Cork University Hospital we have developed (as part of a national stroke programme) a comprehensive Stroke service over the past 4 years. We have encountered difficulties in the post acute management of that cohort of patient who require placement elsewhere with support in the community. We are now implementing a community support service with therapies commencing later this year – again supported by the national programme who have recognised the importance of the patient pathway seamlessly extending from the hospital to the community.
I think the financial value of such an initiative needs to be looked at in the context of the “opportunity cost” of not investing in community services which effectively means slower throughput of patients, longer lengths of stay and the capacity to treat other patients foregone which may in itself represent financial income foregone.
We are faced with exactly this problem (not only in Cork University Hospital [CUH] but throughout the entire Irish hospital system) and we have implemented over 120 different change inititives that collectively have made the attainment of sustainable solutions to the flow of patients through ED more achievable. These can changes can be viewed in our booklet on Unscheduled Care on http://www.cuh.hse.ie/About-Us/Patient-Quality-Safety/The-Change-Programme-2013-2016/Unscheduled-Care-Patient-Pathway/
The attainment of sustainable solutions is critical because embedding change such that it becomes part of the organisation’s DNA and culture is really difficult.
We are now working on getting almost 200 patients who are in CUH over 14 days discharged to community settings in order to create acute bed capacity.