As a care home resident, it is highly likely there will be various visits and stays in hospital – in fact, a high proportion of all admissions and readmissions to hospitals are from residents in care homes. Care homes in South London have frequently expressed a need for better information sharing and communication between themselves and hospital teams during transfers of care into hospital. In many cases hospitals are unable to provide any information to care homes on residents’ care due to confidentiality and on discharge there is often a lack of information on changes to medication or care needs. Worse still, on many occasions, residents discover their belongings are often lost while in hospital.
On the other side of the equation, hospital teams have expressed frustration at the lack of standard health information needed from care homes when residents are admitted – this means hospital staff are often using up time and resources to call care homes to ask for simple information on say mobility or catheters. Various unnecessary tests may be carried out in hospital simply because doctors don’t have the information they need. All in all this often leads to frustration on both sides and ultimately poorer quality of care and longer stays in hospital than necessary.
In 2015 Sutton CCG, St Helier Hospital, London Ambulance Service and Sutton Care Homes, working as part of the Sutton Homes of Care Vanguard Programme, decided to create a new co-designed hospital transfer pathway, with all key partners agreeing the standardised information required between everyone to improve the resident-patient pathway. To ensure all the information and patient belongings were kept in one safe place, a ‘Red Bag’ was initiated so that the resident could be easily identified as a care home resident and all medications, personal belongings (such as hearing aids and glasses), standardised health and medical information could safely go with the resident both to and from hospital.
An important feature of this process was getting care home and hospital staff to speak to each other about the information they needed for admission and discharge. This included advanced care planning information and information about dementia, personal preferences and challenging behaviour.
Once implemented, the Red Bag Pathway began to show positive results, with Sutton CCG finding that residents going to hospital with the red bag and standardised information stayed on average 4 days less in hospital compared to the previous period. Going forward, it is anticipated that cost savings will be found from reduced length of stay for care home residents and from a reduction in replacing lost belongings such as, dentures, glasses and hearing aids.
The Health Innovation Network has been supporting South London boroughs to adopt and implement the red bag pathway for the past 12 months. We have provided training, advice and resources for CCGs, NHS Trusts and care homes, helping boroughs to go through the steps needed to set up the pathway and overcome any challenges. The HIN will also be carrying out further evaluation of the pathway to evidence improvements in care.
The Health Innovation Network (HIN) is the Academic Health Science Network for South London. Our role is to support the adoption and spread of evidence based practice in health, social care and innovation across the South London Boroughs, CCGs and NHS Trusts. The HIN’s Healthy Ageing Team has been supporting the rollout of the ‘Red Bag’ pathway, improving care for care home residents.