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Perfect Week

Numerous East Birmingham residents either avoided an unnecessary hospital admission or were discharged from hospital earlier than planned to receive treatment in the community thanks to a 'perfect week' event that took place in parts of East Birmingham.

The perfect week is part of a national initiative to provide support to hospitals to improve their emergency and acute care. Its particular focus is to examine avoidable causes of long patient stays in hospital emergency departments or wards.

The week-long activity focussed on providing support to all residents living in East Birmingham who had either attended the emergency department at Heartlands Hospital or who had been admitted to hospital and are now medically fit for discharge.

Associate director of transformation Matthew Forrest  said: “We know that people recover more quickly in the comfort of their own surroundings. We can support them to do this by offering more co-ordinated services and support at home, rather than people spending more time in hospital than is necessary.

“The perfect week was our opportunity to remind primary care and hospital colleagues of what community services are out there or to introduce them, and their patients to new services that we have developed.

“These include the two-hour urgent community response service for people who need urgent care in their own home, remote monitoring on virtual wards, the early intervention community team and onward referrals to long-term condition services; people do not always have to go or stay in hospital.

A central operational team was co-located between Saltley Health Centre and Birmingham Heartlands Hospital. Many more staff members working on the front line in the hospitals, GP surgeries and community and voluntary organisations were also involved.

BCHC chief executive Richard Kirby said: “The experience has given us much that we can use to shape our work into the future. We have seen positive impacts for individual patients, including avoiding hospital admission and getting home sooner. We will be reporting on what we have found and the things we can adapt.

“We have gained a much better understanding of urgent and emergency care demand in the East Locality, and what we can do to help people who need our services.

“Thanks to all who have been involved, and I look forward to sharing more following our de-brief.“


COPD Pathway

During the seven-day exercise in November, the Perfect Week team set out to trial a new care pathway for COPD patients by shifting the balance away from care in hospital to care in the community.

Seven East Birmingham residents with COPD who frequently needed to phone for an ambulance and/or visit A&E because of respiratory problems were invited to be part of the trial. Each was provided with remote monitoring equipment, consisting of observations kit and an IPAD and asked to send in daily readings.

Upon patients inputting results, they were transferred to a live dashboard within the East Locality Hub where clinicians were on hand to interpret the results.

On day two, Mr Brown’s readings triggered an alert with the team who immediately phoned to conduct a triage. After a brief assessment, a referral was made to the urgent community team who visited Mr Brown within two hours. He was prescribed a steroid inhaler.

The Perfect Week team have, to date, managed to keep him safe at home with the home monitoring equipment, GP intervention and regular follow ups


Mrs Jones

Enabling Mrs Jones to return home from hospital more than two weeks earlier than expected was one of the early patient results of the Perfect Week.

Mrs Jones was waiting to be discharged from Solihull Hospital; but she could no longer manage the stairs and needed a ground floor room turned into a bedroom before she could return home.

The ideal room was full of large items of furniture which would have prevented the installation of a bed. Despite their best efforts, the family could not get these pieces of furniture moved for another fortnight; Mrs J was stuck in hospital until this happened.

Mrs Jones triggered an alert on the discharge hub list as being delayed in her discharge and the perfect week team stepped in to see if it could help. With agreement from the family, the team arranged for removal of the furniture the very next morning. It organised the loan of a bed while the family waited for a new one to be delivered.

Mrs Jones would also be needing support from the early intervention community team and the referral was sent to the team to prime them to be ready. The loaned bed arrived the next day.

The result was that Mrs Jones returned home two weeks earlier than planned. Not only did this free up a bed for somebody who needed it more but it meant that Mrs J could recover more quickly in the familiarity of her own home.



Philip, a Birmingham man in his mid-80s with dementia, was admitted to Heartlands Hospital after a fall. He was diagnosed with a mild acute kidney injury, which could potentially keep him in hospital for several more days while it was treated by antibiotics.

Philip didn’t want to stay in hospital and he made this very clear to his care team. The perfect team stepped in and discharged Philip home into the care of the BCHC frailty virtual ward; Philip was able to return home which is where he wanted to be.

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