Urgent Care Workshop:Avoiding Admissions

Dr Caroline BennettCCG lead for Urgent Care

12/06/14

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The National Urgent Care Context

“the reality is that millions of patients every year seek help for their urgent care needs in hospital who could have been helped much closer to home. For example, we know that 40% of patients attending A&E are discharged requiring no treatment at all; there were over 1 million avoidable emergency hospital admissions last year; and up to 50 per cent of 999 calls requiring an ambulance to be dispatched could be managed at the scene.”

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Key Drivers in our Local System

Apr-Jun 13

July – Sept13

Oct-Dec13

Jan-Mar 14

Total

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Our Programmes of Work

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Signposting

• SPCA development

• Ambulance clinical desk

• 111: increasing clinical input

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The Single Point of Clinical Access

Debbie Gray, Community Manager, Capacity, Gloucestershire Care Services

SPCA

• Rapid Response

• Urgent or next day assessment by integrated community team

• Community hospital beds

• Reablement beds

• Rapid clinician to clinician conversation with medical, surgical, General and Old Age Medicine (GOAM) and palliative care colleagues

• District nursing out-of-hours (OOH) services

• Home-based IV therapy intervention

• Specialist nursing teams, such as respiratory, where a next day response is adequate

• Same or next day review at the Ambulatory Emergency Care Unit (AEC)

• Same or next day respiratory hot clinics at Gloucestershire Royal Hospital

• The new deep vein thrombosis (DVT) pathways

Our knowledgeable clinicians will work with you to agree the most appropriate pathway with you and can access:

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Admission Avoidance• OPAL

• Primary care enhanced service

• Paediatric pathways

• Ambulance non conveyance 41.2%

• DVT service

• ICTs

• Rapid response

• Monday – Friday service between 09.00-17.00hrs

• Based at GRH• Consultant Geriatricians review any patient

over 65 with a frailty indicator and produce Comprehensive Geriatric Assessment

• Care management and discharge plan agreed that meets the individual’s needs and is supported by the Integrated Discharge Team and Rapid Response Service.

Separate workshop runningIn Gloucester and

CheltenhamMulti-disciplinary teams

Access via SPCA

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Paediatrics

Paediatrics

• GP Consultant Advice Line

• Next day hot clinics

• Big 6 guidelines

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Paediatrics: Big Six Guidelines

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Rapid Response Service

Senior clinician assessment within 1 hour of referral through SPCA

Advanced health assessment, diagnosis and intervention for up to 48 hours to avoid an unnecessary admission24 hour service, made up of nurses, therapists and paramedic staff who undertake

complete care of patients who are acutely unwell, but who can be safely managed at home.

Staff advanced health assessment trained and develop plans of care which may include, SC or IV fluid therapy, IV antibiotic administration, prescribing for acute illness presentations, canulation, nebuliser therapy, and urgent symptom control for palliative

care patients.

Supported by access to an overnight urgent care support service, they tailor care to the patient’s need and can visit multiple times daily if the patients situation requires.

A promotion of self management and patient empowerment help to manage the initial acute phase of illness and proactively support future care planning

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Acute care

• Hot clinics – respiratory and paediatrics (cardiology coming)

• Streamlining Urgent Care

• Ambulatory Care

Ambulatory Emergency Care

Lou Buckle and Jemma Walker

Advanced Nurse Practitioners

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What is AEC?

A national initiative designed to:

– Improve patient care

– Assess, diagnose and treat patients within the course of a day, with or without follow-up care

– Reduce emergency admissions

– Ease pressure on Emergency Departments

– Take referrals from EDs and GPs

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Who is Suitable for AEC?

Patients are identified as being suitable for AEC in two ways:

1.Use of the Amb Score system – patients with a score of >=5 can be considered.

2.Pathway approach – patients with particular conditions e.g. Cellulitis or Pleural Effusion.

The units have seen 891 new patients*. 151 were referred directly by a GP (via the SPCA), avoiding an unnecessary ED attendance.

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Where are the AEC Units?

• Cheltenham General Hospital – 3rd Floor, College Road Wing.

• Gloucestershire Royal Hospital – Ground Floor, Gallery Wing.

• Both units are open Monday – Friday 10am to 6pm (with last referral / arrival time at 4pm).

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How Can I Refer?

• Via the Single Point of Clinical Access (SPCA) on 0300 421 0300.

• The SPCA will conduct the Amb Score with you, to help determine if your patient is suitable for AEC.

• For more information about AEC please visit the GP pages of the Trust website: http://www.gloshospitals.nhs.uk/en/Staff-and-Healthcare-Professionals/

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Key messages

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Your input to our work

• Which of the services we’ve outlined is of most use to you – place a star

• What do you think’s working well in each area/service?

• What do you think we need to do to improve access to alternative services in each area?

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