Improving patient flow through supported discharge and community care

Improving patient flow through supported discharge and community care

Operating a ‘Better Together’ approach, several Acacium Group businesses collaborated on a bespoke solution to accelerate patients safely through the hospital and get them the quality care they need at home.


  • 588 hours of care provided per week
  • Average referral from internal discharge teams reduced to 9 hours
  • 100% utilisation of HCA support

The challenge

With ongoing patient flow challenges intensified by COVID-19, Chesterfield Royal NHS Trust had limited capacity to deliver care in the community. This resulted in high numbers of patients staying in hospital despite being well enough to go home.

Unnecessary hospital stays and the uncertainty around discharge plans and time scales caused concern to patients and families, in addition to blocking much-needed acute beds for other patients.

Why Acacium Group?

The scale and the diversity of Acacium Group’s health and social care offering support the provision of wrap-around services, helping patients get the specialist care they need in the comfort of their own homes. Through effective partnerships and collaboration, Acacium Group has facilitated nearly 50,000 patient discharges from around 400 care settings in England and Wales since 2020.

The solution

Working in collaboration, Pulse Nursing at Home, part of Acacium Group, and Xyla, part of Acacium Group, were contracted to implement a uniquely patient-centric end-to-end service to help alleviate the Trust’s patient flow challenges.

The team worked with stakeholders at every touchpoint, impacting patient flow and operating as an extension of the hospital’s discharge function. The fully managed service provided visibility of the process, allowing the team to quickly address delays and identify and overcome discharge barriers for medically optimised patients.

The team worked closely with Chesterfield Royal NHS Trust to identify patients well-suited who would benefit from supporting the discharge service. Managing communication between all parties, they were able to establish clear expectations with both patients and their families while ensuring that all partners within the system remained well-informed

Utilising Pule Nursing at Home’s extensive network of healthcare assistants (HCAs), a pilot scheme was launched to provide 175 hours of community care. HCAs were assigned on a 12-hour basis providing packages of care for those needing help with tasks such as washing and dressing.

Tailoring to individual patient requirements, either one or two HCAs were allocated to conduct home visits, ranging from one to four times daily and lasting between 20 minutes to an hour. Encouraged by early success, the pilot programme swiftly expanded to provide 588 hours of weekly care. This escalation significantly increased capacity and enhanced the quality of patient care.

The patient’s next of kin

“I cannot begin to think where my Dad and I would be without your carers and the exceptional care they provide. When I realised he would need carers due to his needs changing, I didn’t know what to expect. I didn’t know how they would be and how my Dad would feel losing some of his independence – then Wellington arrived, and all the worry disappeared. He was such a lovely man and gave my Dad the respect and dignity he deserves. The carers have all been wonderful”


Mobilising care in the community

Pulse Nursing at Home secured 100% utilisation of HCAs, enabling patients to return home with a sustained package of care in place. Operating seven days a week, the service ensured patients could return home when deemed medically fit rather than delaying discharge due to a lack of needed support in the home. The flexibility of the service also allowed the hospital to secure efficiency savings, scaling the service up and down to meet demand when facing seasonal pressures, for example.

Improved patient experience

Patients and their next of kin were kept informed during the discharge process. Actively managing communication with everyone involved helped set expectations and reduce anxiety by making the discharge process easier to understand.
Facilitating care in the home improves patient rehabilitation rates and increases capacity by reducing hospital readmissions. Evaluation of discharge services is overwhelmingly positive, with more than 95% of families declaring the service ‘excellent’ or ‘good’.

Increased optimisation and utilisation

By setting up a comprehensive and managed service, the Group was able to efficiently release essential resources and capacity by rapidly discharging patients. This cooperative strategy significantly improved the overall flow within the Trust’s system.
Initially, the pilot aimed for a four-hour window to accept or decline a referral. However, this performance benchmark was swiftly surpassed as a dedicated team managed to process referrals within just 15 minutes.

Data-led insights

As the discharge project has evolved, so have the reporting measures. The information now shared with the Trust covers referrals, placement, utilisation and reporting on the patient’s independence. This clarity enables the Trust to enhance its workforce planning capabilities. The ongoing data initiative assists Trust leaders in highlighting the service’s value and its returns on investment, leading to consistent extensions and renewals of the contract.

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