Introduction Fast Track Continuing Healthcare (CHC) is a care package, funded and arranged by the NHS when a person is identified as having a ‘rapidly deteriorating condition that may be entering a terminal phase of life’ (National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care, 2018).
Methodology Various initiatives were developed and implemented to provide guidance and improve the process:
Direct electronic referral to CHC;
Fast Track Operational guidelines detailing roles and responsibilities of staff;
Integrated Discharge Team accountable for Fast Track referrals and discharge;
Patient information leaflet;
End of Life care: a guide – a booklet for people in the final stages of life and their carers (Macmillan Cancer Support and Mare Curie, 2015);
Community services leaflet with contact telephone numbers;
Discharge toolkit on the hospital intranet;
Discharge prompt stickers for medical notes;
End of life care facilitator attendance at daily ward board rounds;
Robust data collection and reporting on Fast Track discharges.
Implementation The audit data for this time period revealed a reduction in length of stay (LOS) from baseline data of six days (from 22 days to 16 days) and a reduction in admission to clinical decision to Fast Track by two days (from 15 days to 13 days) and the Fast Track process time has reduced from 7 days to 2.5 days.
Cost savings This equates to a saving of £615,600 based on the average cost of an acute bed price of £300 per day and 2052 beds saved (11 beds).
Conclusion Improvements have been made in the consistency and quality of data collection which is informing performance and evaluation of the process. Initial audit has shown that changes to how we approach Fast Track discharges have shown good progress in reduction in average length of stay and clinical decision making.
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