1. Red Bag Hospital Transfer Pathway:
Sutton Homes of Care Vanguard, Sutton CCG
Viccie Nelson, Vanguard Programme Director
Christine Harger, Quality Assurance Manager

2. Sutton Homes of Care: The Programme NEW MODEL OF CARE
Our vision is to have vibrant, high-quality care homes in Sutton delivering care that embraces the national nursing values of patient care – Care, Compassion, Competence, Communication,
Courage and Commitment (the ‘6Cs’).
NEW MODEL OF CARE
Integrated Care
Care Staff Education and Development
Quality Assurance and Safety
The vision is implemented through the three ‘pillars’

3. What were the issues?
Care home managers forum with our partners revealed there were several issues with the admission/discharge of care home residents from all organisations

4. How we achieved this? Issues identified No standard paperwork
Lost documents
Loss of residents’ belongings
Medicines disappear
No system in place to track residents through the hospital
Care homes find it difficult to get information from hospitals
Care homes receive lots of phone calls about the residents’ clinical ‘situation’
Poor communication between hospitals and care homes on discharge
Residents staying in hospital for longer periods than necessary
Solutions proposed
Transfer bag
Standard paperwork to assist ambulance staff and A&E staff
Baseline information about the resident
Better communication between care homes and hospitals at all points of the resident’s journey
Senior staff from care homes to visit residents in hospital within 48 hours of admission

5. What were the results? A pathway
Short film:
If possible please could you have loaded the video below that explains the pathway
Hospital Training video:

6. What were the results? A set of principles
Every resident has a red bag that contains their personal information documents, their medications and their belongings and clothes for travelling home in
Every point of contact in the resident’s journey from care home to hospital knows their personal information (who they are, what their health and social care needs are when they are well, and what their wishes and preferences are).
Every person who meets the resident knows what the reasons are for them going into hospital
Every care home manager or nominated deputy is available to support the resident whilst in the hospital, visits within hours of admission and is involved in the episode of care
Every resident, or if they don't have capacity, their lasting power of attorney or a best interest decision, consents to their personal information being shared between the care home, the hospital and the ambulance service
Every relevant hospital and ambulance service staff communicate all relevant information about the resident with each other and with the care home

7. What were the results? Training resources and films

8. What were the results? Consent - hospital and care homes talk!
“I didn’t know the patient was on thickener [for drinks] until I looked through the red bag”
“Before the red bag we would spend ages on the phone trying to get information about the patient, now the information and their medicines are all in one place, its saved our time immensely”
Consent - hospital and care homes talk!
Highlights specific and holistic care needs
Smoother – quicker handover
Care homes visit their residents
Nursing summary for continuity
Timely and appropriate interventions
NICE Guidance (NG27)
“The documentation gives me all the information I need to ensure the patient has the best chance of making an excellent recovery after their surgery”

9. “Definitely helpful for the acute take”
Great feedback
“Patient can be aggressive but tips included about talking to him about his wife and has been so much easier to care for him. Might usually take 2 hours to find out this information and sometimes might never find out!”
“A good organised comprehensive approach enabling clinicians to obtain a complete picture, especially in cognitive impairment.”
“I didn’t know the patient was on thickener [for drinks] until I looked through the Red Bag”
“Definitely helpful for the acute take”

10. Impact to date
179 residents of care homes have been tracked through our local hospital in the last 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
Note: Data kindly collected by Integration and Transformation
Team and Older People Nurses at our local hospital

11. Great care for our residents
Sarah on at 02:05 – 05:21
A care home residents perspective

12. Where do we go from here? Sustainability GREATER LONDON NORTH AMERICA
NORTH AMERICA
GREATER LONDON
SINGAPORE
Simple idea- people think its theirs- ownership hopefully leading to sustainability

13. Great care is a partnership
Sutton Homes of Care
Great care is a partnership