Northampton General Hospital

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment we did not rate as we only looked at specific aspects in response to the Section 29a Warning Notice (WN). The rating has remained as requires improvement.

We assessed 2 quality statements and found improvements had been made in line with the WN. The hospital had launched a programme to improve patient flow and the timely and safe discharge of patients. This included reviewing internal discharge processes, introducing enhanced digital oversight tools, and a discharge planning approach from admission. Action had been taken to develop strong system-wide collaboration with community and social care partners. Early data reported reduced long stays and faster completion of discharge paperwork indicated a 5–10% increase in discharges before midday,

Processes to improve the accurate and timely prescribing and preparation of medicines to take home had resulted in reducing the risk of patients experiencing delayed discharges.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Improvements had been made to systems and processes to support patient flow.

Quality Statement Score: Not scored

We previously found concerns that processes to support patient flow through medical care were not effective. During this assessment we found improvements had been made.

A hospital wide Transfer of Care form had been introduced. This prompted staff to record information necessary to support efficient discharges to the discharge hub. It would reduce delays caused by missing or incomplete information.

The mix of patients on some wards had been reviewed. Wards which specialise in only one type of patient i.e. orthopaedic. These wards can focus on having a single discharge policy and pathway instead of multiple pathways which increases the risk of errors and poor discharges. One ward, Nye Beyan, which had become a dedicated medical speciality ward, reported a reduction in the number of patients who stayed on the ward for a long time and a reduction in medical outliers in surgical wards.

The trust had changed how it conducted its multidisciplinary board rounds (MDTs) to identify inpatients’ potential discharge needs upon admission (e.g. community support, equipment and social care).

Reviews of each patient’s discharge plans and status had been introduced in the twice daily multi-disciplinary board rounds. At each board round a member is now required to record on an electronic system if a patient needs to remain in hospital or is fit for discharge. Patients required to stay in hospital are given an estimated discharge date. This helps staff to plan any resources patients may require supporting their safe and timely discharge. The electronic system immediately notifies a dedicated discharge team of any patients recorded as fit for discharge and highlights patients who have exceeded their expected discharge date (EDD). This enabled managers to take prompt action to resolve the barriers for these patients. The trust reported the new MDT process and electronic system has improved consistency in practice across the trust, ensuring board rounds took place twice daily and patients fit for discharge are identified promptly. Planning early and continually reviewing patient needs could help avoid delayed and unsafe discharges or the need to readmit patients.

The Integrated Discharge Hub multi-disciplinary team now met twice every weekday – morning and afternoon – to review discharges and any delayed cases. The morning Hub meeting reviewed patients who became fit for discharge the previous night or in the morning. This improved the time for patients who will require support after discharge, being allocation to community health or social care teams. The afternoon meeting followed up any ongoing issues with these discharges and prepares discharges for the next day. The trust reported the increases in meeting frequency had improved responsiveness. A patient identified as fit for discharge in the morning could now be referred to and accepted by the discharge team by the afternoon, rather than waiting until the next day.

The site management team now included transport coordinators in daily bed meetings. This enabled patient transport to be planned earlier in the day. This had reduced delays and the risk of patients fit for discharge having to stay an additional night due to the lack of available transport. The trust reported this new approach had reduced the frequency of late transport cancellations.

The trust had reported the Discharge Lounge (DL) processes had changed to improve flow. The DL served as a safe waiting area for patients who have been discharged from wards but are awaiting final arrangements to be completed (e.g. medications, transport, paperwork) before leaving the hospital safely. Staff education had been conducted to raise awareness of the benefits of sending suitable patients to the DL earlier in the day. Facilitating earlier discharge reduces the risk of patients being referred too late and having to stay another night. The DL now accepted patients in the evenings and overnight if needed. This had the potential to free up ward beds earlier, increasing availability for new admissions. The trust had plans in progress to make the DL available 24 hours a day.

A data system had been introduced to monitor how the DL is being used, length of stays and outcomes for patients. This allowed the team to identify times of high demand, delays in the discharge pathway and if resources and process are being effectively managed. The system identifies areas which did not use the DL allowing senior staff to encourage their engagement.

Patient flow processes had been reviewed, including the introduction of real-time tracking of patients in the DL. Wards were now instructed to notify the DL when a patient is fit for discharge rather than delaying until the ward has completed all the discharge tasks. This reduced waiting times by enabling the DL staff to access records and be prepared for the patients’ arrival before they leave the ward. Being prepared for a patient’s arrival could reduce the length of time a patient would need to spend in the DL, thus freeing up space for more patients to access the DL. The trust reported these changes have had a positive impact by freeing up inpatient beds earlier and helping to admit patients from the emergency department (ED) or assessment units more quickly. The trust was monitoring the DL data monthly and has reported an actual increase in the number of patients accessing the DL each day.

Patients identified as possibly requiring support upon discharge were flagged to discharge coordinators (DCs). This enabled DCs to prepare for the appropriate support being in place so these patients could be discharged without delay. Patients identified as having no medical reason to remain in hospital were also reported each day. The trust had told us that since the daily reporting of these patients was introduced, staff had escalated these patients earlier to senior staff to identify appropriate solutions.

There was a dedicated team to manage complex discharge delays. These were patients who required further support once they leave the trust. Delay may be due to a variety of reasons such as, requiring a rehabilitation bed, awaiting social worker allocation and family choices. These delays were discussed in a daily call with the local authority and Integrated Care Board (ICB) to identify timely solutions. The ICB is the NHS England body which plans all local health services.

Community physiotherapists and reablement teams from Northamptonshire Healthcare NHS FT (NHFT), the trust’s community and mental health provider, now visited patients earlier to identify those who are likely to require community beds or support at home. This will help to ensure resources required in the community will already be place when patients are ready for discharge, thus avoiding delays. To address waiting times for community beds, the trust held a 2-day workshop with stakeholders to review each patient requiring a community bed and whose discharge was delayed. The trust reported that this resulted in 29% of those patients being discharged and intend to regularly repeat the event.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Quality Statement Score: not assessed

There was a greater awareness and understanding of the impact accurate prescribing and the timely availability of medicines had on discharges. Improvements had been made to support the earlier identification and supply of medicines to people waiting to be discharged.

The trust’s electronic discharge notes (EDN) system now has an integrated prescriptions to take out (TTO) function. Doctors can write TTO medication orders within the same workflow as the EDN. This integration meant once a discharge prescription was written and electronically signed and sent, it was instantly visible to Pharmacy. Pharmacists could begin processing TTOs sooner without waiting for paper forms and could see the EDN context to check the medicines were suitable for the patient. The new system also allowed the monitoring and effectiveness of the process by providing electronic timestamps for each step to identify any delays and how the process could be improved. The Pharmacy Department had an ongoing project to improve and streamline TTO dispensing. The pharmacy has protected “discharge script” staff to prioritise EDN/TTO prescriptions over routine in-patient tasks. This will help to reduce the number of discharges delayed due to medication waits.

The trust had reported that the Pharmacy leadership was working with its Digital team to develop a report showing the end-to-end discharge timeline: when the discharge order was placed, when pharmacy received it, and when medications were ready. Once in place, this report will provide quantitative evidence of improvement and where further development may be required to improve patient flow.

The trust had formed a multidisciplinary working group with representatives from Medicine, Pharmacy, and the Quality Improvement team to tackle TTO delays. They have trialled interventions such as a bleep system specifically for urgent TTO queries and a cut-off time for routine TTO requests (with exceptions for critical cases). An outcome of this collaboration was improved communication: e.g., pharmacists now attend the afternoon ward rounds or huddles on some medical wards to start planning for the needs of patients who are fit, or nearly fit, for discharge. Also, if a discharge prescription is unusually complex, pharmacists would engage earlier with the prescriber to ensure accuracy and avoid last-minute issues. These changes were reported as contributing to smoother and faster TTO completion.