The Hospital Transfer Pathway Red Bag Scheme

October 2018

www.cornwall.gov.uk

The Red Bag concept

The Red Bag scheme was first implemented in Sutton (NHS Vanguard site) as part of the Hospital Transfer Pathway implemented in 30 care homes. Sutton CCG identified issues around transfers from the care home to hospital and from hospital to the care home around communication, handover times, and follow-ups. Through standardisation of paper work and keeping the person’s belongings in one place, the Red Bag has led to:

• improvement in communication and relationships between hospital and care homes

• fewer phone calls and follow ups made by the hospital staff to the care homes looking for health information about the person

• smoother admission and discharge processes

• better person-centred care

• An average reduction in Length of Stay to 4 days

www.cornwall.gov.uk

Evidence Based Practice

Sutton Vanguard Site

• 179 residents of care homes were tracked through Sutton hospital over nine months

• Average length of stay with a bag was 13.4 days, compared to 17.4 days without a bag

• Residents with a Red Bag spent 4 days less in hospital than those without a Red Bag.

Approximately 50% of the country has now implemented the scheme

www.cornwall.gov.uk

The Cornwall Red Bag Pathway so far…

• The Red Bag Pathway has been developed in partnership with Cornwall Council, NHS RCHT and NHS Kernow Commissioning Group , Care Home providers , CPIC, E Zec ,Cornwall Partnership Foundation Trust, South West Ambulance Service Trust and other partners in the locality

• A Stakeholder Task and Finish Group has focused on what to include in the Red Bag that can improve:

• The person’s experience

• The person’s pathway

• Communication

• Reduction in length of hospital stay and avoidable readmission

• The Task and Finish Group has agreed a set of 6 documents that work for the stakeholders. The group will also measure impact and ensure future sustainability

• The Task and Finish Group have agreed a style of Red Bag that meets infection control requirements and will allow the person to take their belongings and documentation with them.

www.cornwall.gov.uk

The magic of the Red Bag

• 2 or 4 bags allocated per home depending on size and need

• Serial number to track

• Space for name tag on front

• Spacious inside to hold change of clothes and personal items

• Separate compartment inside to hold glasses and visual aids, dentures, hearing aids and other personal aids

• Sleeve on side to hold paperwork (securely fastened with Velcro)

• Includes a set of cleaning instructions

www.cornwall.gov.uk

Red Bag Checklist

• Red Bag Serial Number

• Person and Care Home Name

• Items in the Red Bag

• Documentation

• Residents Belongings

• Medications

• Discharge Letter/Summary

www.cornwall.gov.uk

Red Bag Pathway – How will it work (1)

There are specific requirements of staff at each stage of the Red Bag Pathway Care Home Staff: When an ambulance is called for the person, and the person is being admitted to hospital the care home staff will ensure that all the correct paperwork is completed and included in the Folder at the front of the Red Bag including: Standard Documents

• Red Bag Checklist

• Assessment Form: ‘All About Me’

• Confidentiality Form

• Transfer Pathway Guide, Cleaning Instructions and Return Protocol

Other Existing Documents

• Provider’s Care Plan Summary

• Medication Administration Record (MAR) chart

• Original Treatment Escalation Plan (TEP)

• Advanced Care Plan (if applicable)

www.cornwall.gov.uk

Red Bag Pathway – How will it work (2)

Ambulance staff: Transfer from the care home to the hospital

• On arrival at the care home, ambulance staff will receive the Red Bag from the care home

staff and check to ensure that all paperwork is present and correctly completed

• On arriving at the hospital, ambulance staff will pass on the Red Bag to hospital staff, inform

them that the paperwork is complete and discuss any issues arising ensuring hospital staff are

aware that the Red Bag must stay with the person at all times.

Hospital staff: Arrival at hospital and on the ward

• When advised by ambulance staff that the person is a care home resident, hospital staff will

ensure the Red Bag is present and complete and refer to the person’s enclosed paperwork

• Once the paperwork has been reviewed the folder holding the paperwork will be placed

inside the Red Bag and remain closed at all times

• They will ensure that the Red Bag remains with the person at all times, keeping it with them in the Emergency Department and ensuring that it is placed in their locker or by their bed if

they are transferred on to a ward.

• The ward staff will write on the board above the bed that the patient has a Red Bag

www.cornwall.gov.uk

Red Bag Pathway – How will it work (3) Hospital staff: Discharge from hospital to the care home

• Hospital staff can identify the person as a care home resident, by the presence of the Red Bag , allowing them to consider an earlier discharge.

• The discharge should be discussed fully with the care home manager or a representative to ensure that the care home is prepared for the discharge.

• When the person is ready for discharge, a ward nurse will pack the Red Bag ensuring that all the correct paperwork is completed including the person’s Discharge Letter/Summary

• They will also ensure that the Red Bag contains any To Take Out (TTO) medication prescribed by the hospital with clear instructions for care home staff, together with all the personal belongings that came in with the person (this can be confirmed by referring to the checklist ).

www.cornwall.gov.uk

Red Bag Pathway – How will it work (4) Ambulance/Patient Transport staff: Transfer from hospital to the care home

• The Ambulance / Patient Transport staff will receive the Red Bag from the hospital staff and ensure that it stays with the person at all times.

• On arrival at the care home, they will hand over the Red Bag to the care home staff

Care home staff: On arrival at the care home

• When the person returns from hospital, the care home staff will ensure that the Red Bag is with the person and contains all the correct paperwork, discharge medication and personal belongings

• If anything is missing, they should follow the Concerns process

• Care home staff should clean the bag in accordance with the infection control protocol

• The care home will check all the paperwork including the Discharge Letter/summary

www.cornwall.gov.uk

Why Are We Doing This?

Issues identified by Care Homes and Hospital Staff:

• No standard paperwork

• Lost documents

• Loss of the person’s belongings

• Care homes can find it difficult to get information from hospital staff

• Care homes receive a high number of phone calls about the person’s clinical ‘situation’ prior to their admission

• Inconsistent communication between hospitals and care homes about the person’s discharge plan

• Care home residents staying in hospital for longer periods than necessary

www.cornwall.gov.uk

The Benefits of the Red Bag Pathway

Based on the evidence from other sites, the Red Bag Pathway will help to ensure:

• Safe, timely and appropriate discharge with a reduction in avoidable readmissions

• Fewer phone calls between services

• Less duplication of work

• Less communication breakdown

• Fewer medication problems

• More personalised care and a better experience for people going into hospital

• Fewer harm related incidents

• Reduced risk at the point of discharge

www.cornwall.gov.uk

Advantages for the Person • Supports the person’s journey

• Personal aids are available to the person

• A change of clothes is available for the person to return home in

• Less likely to lose property and personal aids

• Treated with dignity and respect due to information available e.g. ‘All About Me’

• Enhances continuity of care during admission and after discharge

• The person comes home quicker instead of an unnecessary long stay

Advantages for care homes • Saves you time

• Baseline information would be up to date, only need to complete the current episode, i.e. why the person is going to hospital

• Smoother handover to ambulance staff

• Less time spent on phone with the hospital:

• during admission because they have all the necessary information

• after discharge because they have included updated clinical information, TTOs etc.

• Improved infection control

• Opens lines of communication resulting in much better working relationships with hospital staff

www.cornwall.gov.uk

Advantages for the Ambulance service • Smoother handover from care home, and to hospital

• Standardised paperwork between care homes that is easier to use

• More informed clinical decisions

• The person’s belongings are contained

• Better relationship with care homes

Advantages for the hospital

• Time saved

• Informed clinical decisions

• Good communication between care home and hospital

• Patient-centred care as documents highlight needs, wishes and risks

• Better relationships with care homes

• Smoother discharge process

• Improved infection control

• Reduction in delayed transfers and avoidable readmissions

www.cornwall.gov.uk

Questions?