Case study · Acute NHS

Digitising behavioural insight to improve dementia care and discharge

How Melo is transforming behavioural assessment, multidisciplinary decision-making and patient flow on the journey from hospital to home.

Acute NHSDementia and complex careHospital to Home
Group photo of the Liverpool team
Organisation
NHS University Hospitals of Liverpool Group
Sites
Aintree, Royal Liverpool and Broadgreen
Using Melo since
Early 2025
Frameworks
ABC, ABS and ABC+
80,000+

assessments completed digitally

1,000+

staff users across three hospitals

1,500+

patients cared for using Melo

15

wards across three hospitals

Melo platform data.

The challenge

Behaviour recorded on paper, without the detail decisions need

Patients with dementia and other cognitive impairments often present with complex behaviours, for many different reasons. Behavioural observations were traditionally recorded on paper forms, often completed inconsistently and without the structured detail needed for timely discharge planning or multidisciplinary decisions. For hospital teams, that led to five ongoing challenges.

  1. 01Fragmented behavioural data
  2. 02Behavioural risks and patterns hard to identify
  3. 03Inefficient handover between departments
  4. 04Delays in discharge planning and patient flow
  5. 05High administrative burden
Developed with the trust

Evolving behavioural assessment with ABC+

NHS University Hospitals of Liverpool Group has been part of NHS England's Enhanced Therapeutic Observations and Care (ETOC) programme. Through it, the trust recognised the need for a more holistic approach to complex behaviours. Working together, that led to ABC+, which replaces traditional paper ABC charts with a digital approach that captures more of the picture.

Live since 17 February 2026Piloted on 15 wards
  • 01
    Positive behaviours

    Recognising moments of engagement, wellbeing and progress.

  • 02
    Negative behaviours

    Structured insight into behaviours of concern and the circumstances around them.

  • 03
    Sleep

    Another important dimension to understanding a patient's overall presentation.

ABC+ shows how Melo has developed alongside clinical teams, responding to real-world needs rather than simply digitising a paper process.

The ABC+ report in Melo.
The solution

One shared view, from the ward to home

Since early 2025, clinical teams across NHS University Hospitals of Liverpool Group have used Melo as part of their Hospital to Home programme, which aims to improve care for patients living with dementia and complex behavioural needs.

Teams record behavioural observations in Melo, at first using a structured Antecedent, Behaviour, Consequence (ABC) framework or the Agitated Behaviour Scale (ABS), and now using ABC+ alongside the scale. They see results in real time, spot emerging patterns and bring them into MDT discussions and discharge planning with the Transfer of Care Hub (TOCH) and community bed brokerage teams.

Live across
Aintree University Hospital
Royal Liverpool University Hospital
Broadgreen Hospital
One view forNursingCare staffTherapyPsychologyDischarge teams

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The impact

What changed on the wards

01

Better quality behavioural insight

Real-time digital entries replace paper forms, improving the completeness and accuracy of assessments. Staff no longer chase fragmented notes or wait for psychology reports, which saves administrative time for direct patient care.

02

Earlier identification of trends and patterns

Teams spot behavioural patterns sooner, including time-of-day agitation, environmental triggers and responses to interventions. Earlier detection supports proactive care and clinical decision-making.

03

Improved communication across teams

A shared view of patient behaviour across nursing, care staff, therapy, psychology and discharge teams reduces duplication, builds a common language and helps staff act confidently on real-time information.

“We have had no rejected discharges on one of our General Medicine wards at Aintree since introducing Melo.”

Ged Jennings, Enhanced Therapeutic Observations and Care Lead
04

Greater confidence in discharge decisions

Ward managers, patient flow coordinators and the Transfer of Care Hub now use Melo's insights to inform decisions about discharge suitability, making handover smoother and helping patients move into appropriate community settings.

Results

Results at a glance

77%feel confident using Melo
64%found Melo supports discharge planning
59%said Melo helps with behavioural analysis

Staff survey, self-reported.

The trust also reported
  • Improved data quality and auditability
  • Less time spent producing information for discharge planning
  • Paper ABC forms removed from wards
  • Better visibility of patient behaviour across teams
  • Faster identification of behavioural patterns
  • More support for discharge planning
Patient stories

Two admissions, in detail

Bringing behavioural insight to complex care

A patient with a learning disability and a dementia diagnosis was admitted after his community care team raised concerns about a noticeable change in his behaviour, and whether his accommodation could still meet his needs.

During a 24-day admission, including periods of ETOC, staff recorded more than 50 observations of his behaviour. Sixteen described him as settled, capturing calm and positive moments. Some behaviours first seemed severe, but reviewing them on Melo's structured timelines gave context and showed that many were less concerning than they first appeared.

Using Melo, the team could spot patterns and triggers more easily and understand how his behaviour changed over time. The Learning Disability Team reviewed behaviours remotely, gave timely guidance and supported care planning. Staff shared clear, structured insight in MDT discussions and discharge planning, making the transition to community partners smoother.

24
day admission, including ETOC
50+
observations recorded
16
described him as settled
Every observation during the admission
  1. AdmissionConcerns raised by his community care team
  2. On the wardObservations recorded in Melo, including during ETOC
  3. Remote reviewLearning Disability Team reviews his behaviour
  4. MDTStructured insight shared in discharge planning
  5. HomeMoves to a more suitable community care setting

“He looks the happiest we have seen him in a while… the discharge went smoothly.”

A member of the patient's family

Seven security calls in six days, then a discharge with no readmission

The patient was well known to the clinical team after three hospital admissions since 2024, one of which had no saved behavioural data. He was referred to the service with low mood and behavioural and psychological symptoms of dementia, to support cognitive stimulation and the de-escalation of behaviours.

Before the referral he had received enhanced therapeutic observations and care. He was also receiving medication to help manage his behaviours, and security staff were called seven times in his first six days in hospital.

Completing the ABS in Melo helped staff identify ways to improve his mood and plan regular weekly activities.

He has since been discharged to a new care home and has not been readmitted to hospital.

3
previous admissions since 2024
7
security calls in his first six days
6
weekly activities planned
His weekly activities
ReminiscingArts and craftsMusicBreakfast clubTalking therapyDancing
  1. AdmissionLow mood and behaviours of concern
  2. AssessmentABS completed in Melo
  3. PlanRegular weekly activity sessions
  4. DischargeMoves to a new care home
  5. SinceNo readmission to hospital

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In their own words

From the people using Melo

Ged Jennings

“Seeing so many staff using Melo and hearing their positive feedback is fantastic. It's helping us understand our patients better and improve their experience in hospital.”

Ged JenningsEnhanced Therapeutic Observations and Care Lead
What staff told us
  • “Melo is always at the forefront of my mind for supporting discharge planning. I can't imagine life without Melo now.”
  • “Staff are happy with Melo and we have now removed all paper-based ABCs off the ward.”
  • “The ability to export behaviour charts directly and share them with the MDT is a major advantage.”
  • “I am finding Melo very helpful. It has really aided clinical decision-making.”
  • “I love how we can capture positive behaviours in Melo and this is pivotal to a patient's care pathway.”
  • “Ward staff are loving it, everyone's on board. They are even training each other, even bank and night staff.”
Watch Ged Jennings talk about Melo33 seconds
About this evidence

What these numbers are, and what they are not

  • Platform figures come from Melo usage data.
  • Survey figures are self-reported by staff.
  • Patient stories describe individual cases and are anonymised.
  • Melo supports clinical judgement. It does not diagnose, recommend treatment or make decisions.
How we handle data and clinical safety
More evidence

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