Supporting Safe Discharge and Continuity of Care at Imperial College Healthcare NHS Trust

Background

As part of its commitment to improving patient flow and ensuring safe discharge from hospital, Imperial College Healthcare NHS Trust partnered with HomeLink Healthcare to address challenges in managing patients requiring complex wound therapies outside the hospital setting.

The collaboration began at St Mary’s Hospital in Paddington, where surgical teams were experiencing delays in discharging patients following vascular procedures. Many patients required Negative Pressure Wound Therapy (NPWT) for wound management after surgery, which created logistical and operational barriers to discharge. Variations in community services across London boroughs meant that consistent support was not always available.

The Challenge

The vascular surgery team faced a recurring issue: patients requiring NPWT were often unable to leave the hospital because of limited availability of pumps. In several cases, pumps provided to community services were not consistently returned to the Trust, creating shortages on the wards.

As a result:

• Patients medically ready for discharge remained in hospital beds.
• Delays impacted patient flow and surgical capacity.
• Patients living alone faced additional challenges managing wound therapy at home.

The HomeLink Healthcare Solution

HomeLink Healthcare was initially commissioned to provide a bridging service for patients requiring NPWT after discharge.

Under the initial contract:

• Pumps were provided under a contracted arrangement with HomeLink Healthcare, ensuring continuity of NPWT after patient discharge.
• Clinical support was provided by HomeLink Healthcare in the community, allowing treatment to continue safely at home.
• Assisted patients living alone who required additional support to manage therapy.

This approach allowed the team to trial the service over an initial six-month period.

When required, some patients were transported home by electric taxi with a HomeLink nurse accompanying them to facilitate safe discharge.

The early success of the programme led to the development of a formal business case to reinstate and expand the service.

Service Expansion

Following the positive outcomes from the vascular surgery pathway, the partnership evolved.

HomeLink Healthcare’s services expanded into additional clinical areas, including Orthopaedic services, supporting post-operative patients and therapy pathways and Medical support, particularly through support for Outpatient Parenteral Antimicrobial Therapy (OPAT), enabling patients to receive IV antibiotic therapy at home.

In addition, HomeLink Healthcare delivered a comprehensive physiotherapy provision to ensure patients remained safe and supported at home following discharge from hospital. This included both same-day therapy assessments for patients requiring immediate input, as well as short-term rehabilitation support for those facing delays in accessing community services. In many cases, where waits for community therapy teams exceeded two weeks, HomeLink’s therapists provided a vital bridging service, helping patients regain mobility, maintain independence, and reduce the risk of deterioration or readmission while awaiting longer-term care.

This expansion helped address another key challenge faced by the Trust: inconsistent community services across different London boroughs. Not all boroughs provided the same level of district nursing support, which could complicate discharge planning. HomeLink’s flexible service model helped bridge these gaps.

Impact

The collaboration between HomeLink Healthcare and Imperial College Healthcare NHS Trust delivered several benefits:

– Reduced discharge delays for patients requiring VAC therapy.

– Improved access to wound care equipment, preventing pump shortages within the hospital.

– Safer transitions from hospital to home, particularly for patients living alone.

– Reduced risk of re-admission through continued clinical oversight, with a low re-admission rate of just 2%.

– Expanded home-based treatment options, including IV antibiotic therapy through OPAT.

– Greater consistency of care across boroughs, helping to overcome variations in local community services.

– Seamless transition of patient care, through close collaboration with community services across 11 London boroughs and Hertfordshire.

Patient Outcomes

Over 1,500 patients were supported by this initiative, reducing their length of stay in hospital by an average of 8 days.

Using EQ-5D-5L, results show that patients are experiencing, on average, a 31% improvement in their self-reported health outcomes (VAS). Specific areas of improvement include

• 23% improvement in mobility,
• 24% improvement in self-care,
• 6% improvement in usual activities,
• 14% improvement in pain and discomfort, and
• 12% reduction in anxiety and depression.

99% patients who received this service said they would recommend it to friends and family.

“Having treatment at home gave me the freedom and joy of being with family. I hope to have HomeLink every time if needed in the future. Thank you to all Nurses and Physios!” – Patient feedback

Conclusion

The partnership demonstrated how a flexible community healthcare provider can support acute hospitals in improving patient flow while maintaining high standards of care.

By bridging the gap between hospital and community services, HomeLink Healthcare enabled more patients at Imperial College Healthcare NHS Trust to continue treatment safely at home, freeing hospital capacity and enhancing patient experience.