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

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. Funding and registration This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. ### Competing Interest Statement Andrew Booth is a member of the NIHR HS&DR Funding Committee and the NIHR Systematic Reviews Advisory Group, and Convenor of the Cochrane Qualitative and Implementation Methods Group. ### Funding Statement This report presents independent research funded by the National Institute for Health Research (NIHR). This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Any additional data not included in this report and its appendices are available on request. All queries should be submitted to the corresponding author. * AA : Admission Avoidance A&E : Accident and Emergency ACU : Ambulatory Care Unit AECU : Ambulatory Emergency Care Unit BRI : Bristol Royal Infirmary CCP : Changing Community Provision C & RC : Care & Repair Cymru CSB : Changing Staff Behaviour CTT : Community Treatment team D2A : Discharge to Assess DHS : Department for Health and Social Care ED : Emergency Department EPOC : Effective Practice and Organisation of Care EPR : Electronic Patient Record ESD : Early-supported discharge FRS : Falls Response Service GP : General Practitioner H2HH : Hospital to a Healthier Home HART : Hospital Avoidance Response Team HMIC : Health Management Information Consortium HIU : High Impact User IC : Integrated Care ICU : Intensive Care Unit NICE : National Institute for Health and Care Excellence PDSA : Plan-Do-Study-Act PECOS : Population-Exposure-Comparative-Outcome(s)-Study Types PPI : Patient and Public Involvement SaTH : Shrewsbury and Telford Hospital SDEC : Same Day Emergency care S : Structural SSCI : Social Sciences Citation Index UK : United Kingdom TC : Targeting Carers