IT EMERGENCY ADMISSIONS
in admissions through GP referrals – at 2pm and 7pm, when GPs had finished their home visits, after seeing patients in their surgeries first. This put a strain on ambulance services as well as the acute trust itself – particularly in the early evening, as the options to stabilise and discharge patients are limited when social care and other community services have shut for the day. To take the pressure off and even out the number of patients arriving at A&E, the emergency department at South Warwickshire has encouraged GPs working in the same practice to rotate their time spent on home visits so the patients weren’t arriving all at once. This benefited the trust and the patients, who might also benefit from more choice of surgery visiting times.
WHY? In addition to knowing who is presenting to the emergency room, it is also helpful to know why – in terms of what medical conditions and the healthcare services they used or considered before they walked in the door to A&E. Of course, not every attendance can, or should, be prevented. There is an absolute and obvious need for emergency services, however, certain conditions may be better suited for a community setting, rather than an acute hospital.
Christine Falzon, pathway lead for
respiratory conditions at Central London Community Healthcare NHS Trust, believes COPD is one of these conditions. The best way to manage COPD patients, Flazon believes, is to have real data on admissions, A&E attendance and GP practice attendance so that patient care can be targeted at those patients who use health services inappropriately. “Where the cause of admissions and A&E attendances is due to poorly managed COPD, specialist community services can improve outcomes, however most services are still poorly equipped to manage patients with anxiety and depression,” she says.
AN INTEGRATED APPROACH
Remember – as a CCG, you’re not a lone island. “Collaboration with other CCGs can prove useful in terms of the sharing of resources, knowledge and costs,” says Murphy. In terms of data management, he
urges CCGs to consider sharing things like data warehousing costs and infrastructure; analysts to interrogate the data on behalf of CCGs; and standardised reports to support the commissioning agenda – i.e. one report generated for all CCGs to show A&E attendances, inpatient spells, outpatient appointments, primary care data such as QOF scores, access rates etc. In the end, integrating data and services
“Unfortunately, the diagnostic information collected as part of the national A&E Commissioning Data Set still demonstrates poor coverage, quality and limited relevance to clinicians or policy-makers”
seems to be the solution. This has worked in Greater London where In a bid to reduce emergency admissions, Jane Wells, service director at Oxleas Foundation Trust, has been working on an integration project between Greenwich Community Health Services, Oxleas NHS Foundation Trust, and Royal Borough of Greenwich, Social Care. The initiative was aimed at providing a collaborative and proactive approach to managing older people with urgent health and social care needs. “We noticed that we’d had lots of good services set up to manage admission avoidance and facilitate discharge, but they had been commissioned
in a real piecemeal fashion,” she comments. “We knew we’d had improvements over the years in our performance in terms of admission avoidance but we weren’t there yet. So, we looked at the key areas we wanted to really knuckle down in and get better.” This turned out to be mostly around community services, intermediate care and social services – so the trust decided they would integrate them. Wells then went about engaging the staff to design a new model themselves. The end result was a Joint Emergency Team (JET), which includes nurses, therapists and social workers; and a Hospital Integrated Discharge Team, to act as points of contact for patients coming and going from A&E, as well as co-located community assessment teams. The result has been a considerable improvement in A&E admission avoidance and attendances.
Sharing data has proved a slight struggle
for Wells and her team. “What we don’t have is joint IT systems,” she says. While this has been a challenge, she didn’t let it be a “showstopper”: “We knew if we tried to fix the IT system, we wouldn’t have achieved any outcomes for the patients.” In the meantime, she says, it’s more important to keep an open communication across health and social care, rather than wait for the perfect IT system – and the same goes for waiting for commissioning to get started. “We could wait until the planets align,” concludes Wells, “or we could just get on with it.”
46 |
WWW.COMMISSIONINGSUCCESS.COM
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72