Discharge to Assess - Demand & Capacity Modelling

During its response to the Covid-19 pandemic, the Buckinghamshire system commissioned a D2A pathway to help relieve pressure on acute hospital beds. Funding has been previously available from several sources to support accelerated implementation, including initial D2A support and Covid-19components. However, it was anticipated that these funding sources would cease, and the system would need to continue to support D2A from existing funding envelopes.

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With that in mind, in 2021 the system sought support from Clarity to establish and manage a D2A demand and capacity model for the system, to inform the efficient management of service pathways and ongoing service planning.

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Initial problems the system and Clarity team faced included:

• Quality issues in key datasets. Data had been captured to meet immediate service priorities rather than recording trends. Datasets did not follow the pathway or outcomes desired to enact change and were limited in helping to understand true demand or address capacity concerns.
• Data flow along pathways was severely limited. Patient details were re-recorded in each service, often without a clear record of the first patient touchpoint – limiting the ability to link flows between elements of the discharge service.

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• Acute dashboard for pathways 0-1 – providing an overview of the impact of D2A on LoS; occupied bed days; where patients present from; presenting conditions.
• Pathway 1 – redesigned Home First data collection processes to follow the pathway and meet the needs of the Executive Board, ensuring high-quality, accurate data to give a complete picture of weekly demand and capacity. Still collected daily and relied upon by the board for decision making.
• Pathways 2 and 3 – collated a reporting mechanism to understand a 5-year forecast of beds capacity and utilisation, how and why volumes have changed and may change over time