What Interventions have been used in the UK in response to Winter Pressures? Mapping review of Studies/Initiatives relating to Discharge Planning and/or Integrated Care

Abstract

Background: Winter pressures are a familiar phenomenon within the NHS and represent the most extreme of many regular demands placed on health and social care service provision. This review focuses on a part of the pathway that is particularly problematic: the discharge process from hospital to social care and the community. Although studies of discharge are plentiful, we identified a need to focus on identifying interventions and initiatives that are a specific response to 'winter pressures'. This mapping review will focus on interventions or initiatives in relation to winter pressures in the United Kingdom with either discharge planning to increase smart discharge (both a reduction in patients waiting to be discharged and patients being discharged to the most appropriate place) and/or integrated care. Methods: We conducted a mapping review of UK evidence published 2018-2022. Initially, we searched MEDLINE, HMIC, Social Care Online, Social Sciences Citation Index and Kings Fund Library to find relevant interventions in conjunction with winter pressures. From these interventions we created a taxonomy of intervention types and draft map. A second broader stage of searching was then undertaken for named candidate interventions on Google Scholar. For each taxonomy heading we produced a table with definition, findings from research studies, local initiatives and systematic reviews, and evidence gaps. Results: The taxonomy developed was split into structural, changing staff behaviour, changing community provision, integrated care, targeting carers, modelling and workforce planning. The last two categories were excluded from the scope. Within the different taxonomy sections we generated a total of 41 headings. These were further organised into the different stages of the patient pathway: hospital avoidance, alternative delivery site, facilitated discharge and cross-cutting. The evidence for each heading was summarised in tables and evidence gaps were identified. Conclusions: Few initiatives identified were specifically identified as a response to winter pressures. Discharge to assess and Hospital at home interventions are heavily used and well-supported by the evidence but other responses, while also heavily used, were based on limited evidence. There is a lack of studies considering patient, family and provider needs when developing interventions aimed at improving delayed discharge. Additionally, there is a shortage of studies that measure the longer-term impact of interventions. Hospital avoidance and discharge planning are whole system approaches. Considering the whole health and social care system is imperative to ensure that implementing an initiative in one setting does not just move the problem to another setting. Limitations: Time limitations for completing the review constrained the time for additional searches. This may carry implications for the completeness of the evidence base identified. Future work: Further research to consider a realist review that views approaches across the different sectors within a whole system evaluation frame.