Modelling resources needed to reduce out of area placements in the Mental Health Acute Care pathway

30 Second Summary

Devon Partnership NHS Trust explored changes to its Urgent Care Pathway to reduce system pressure and avoid out-of-county care. Process mapping and a simulation model identified a need for additional beds. Key findings included high occupancy rates, the necessity to reduce demand and lengths of stay, and the importance of increasing bed numbers to enhance patient care and workforce efficiency.

The research question for Devon Partnership NHS Trust was ’How would Devon Partnership NHS Trust need to change its Urgent Care Pathway in order to reduce pressure in the system and send no patients out of county for care.’ Process mapping was undertaken to understand the system and 3 years of anonymous patient level information (from October 2013 to September 2016) was collected on the care pathway, from referral to discharge.

A simulation model was developed and a number of scenarios were tested to assess the impact on the system of changes in demand for beds, lengths of stay and delayed discharge, and the number of inpatient beds in the system.

There were a number of key findings, which are described later in this paper, including :

There is a pressure in the mental health urgent care system, equivalent to 47 beds. This pressure is managed by purchasing out of area beds and also by running the urgent care system above desired capacity. This means that wards routinely run at above 100% occupancy ; place of safety and extra care areas are used to hold patients whilst waiting for a bed ; leave beds can be backfilled and crisis house beds are spot purchased in some localities.
Both the out of area spend and the extent to which the existing capacity is running ‘hot’ needs to be addressed to reduce the pressure in the system. This will enhance care for patients and the workforce.
There is no one solution and a reduction in demand, lengths of stay (including delayed discharge) combined with an increase in the number of beds is required.
There are not enough beds in the system.
DPT inpatient wards have relatively high occupancy levels, often above 100%, and low lengths of stay. This provides high throughput per bed compared to alternatives, such as step down or out of area beds. As a consequence closing any DPT beds could result in a higher cost alternative.

10-year plan Alignment

SHIFT - Hospital to Community: keeping patients in local/in-county care rather than displaced out-of-area beds. Keeping patients closer to their support networks during crisis allows patients to recover faster and return to their homes/community-based-care sooner.