Cheshire and Wirral Partnership NHS Foundation Trust (CWP) created the Complex Recovery Assessment and Consultation (CRAC) team to ensure that known risks of out-of-area treatment are minimised and quality and safety is improved despite cost improvement pressures. Through working with acute care and care coordinating people out of area, the team utilises specialist rehabilitation expertise, strengthening and streamlining the inpatient care pathway. This contributes to the availability of local acute beds, avoids out-of-area acute care and ensures that people out of area are regularly and thoroughly reviewed and brought back to the local area.
Cheshire and Wirral Partnership NHS Foundation Trust (CWP) created the Complex Recovery Assessment and Consultation (CRAC) team to ensure that known risks of out-of-area treatment are minimised and quality and safety is improved despite cost improvement pressures. Through working with acute care and care coordinating people out of area, the team utilises specialist rehabilitation expertise, strengthening and streamlining the inpatient care pathway. This contributes to the availability of local acute beds, avoids out-of-area acute care and ensures that people out of area are regularly and thoroughly reviewed and brought back to the local area.
A key function of the team work is specialist rehabilitation input to assist and support acute care teams in working with people with the most complex needs. The team therefore works with people who have been inpatients for over 40 days and have no imminent discharge plan. The CRAC team intervenes to assist the acute and community care teams using specialist skills in complex care management to inform and facilitate discharge planning. Team review of the individual ensures that their strengths, needs and aspirations are reconsidered and the views of families and supporters are considered when trying to understand why they are still in acute care. By topping up expertise in acute care, the CRAC team increases the efficiency and effectiveness of person-centred care planning.
The CRAC team is part of the overall innovative approach to acute care pathways in CWP. This has led to a more efficient acute care pathway that almost entirely avoids sending people out of area for acute care. Data collection enabled a regression analysis that found that discharge destination was the significant factor predicting length of stay for people on acute inpatient wards for over 40 days was. Through additional specialist input and coordination in acute care at 40 days, many people are discharged home (57%). If people need complex care placements, CRAC intervention has supported a reduction in the average length of stay for inpatient rehabilitation by 35 days and secure services by 18 days, thus improving throughput and bed availability in local acute care.
