Sue Louth Gemma Aspinall- Urgent Care conference

The AHP Contribution to Urgent and Emergency

Care

Sue Louth, Health Education North WestGemma Aspinall, East Lancashire Hospitals NHS Trust

www.nw.hee.nhs.uktwitter.com/HENorthWest

Overview

Who are the AHPs?

What can AHPs offer to emergency and urgent care?

What are the benefits?

Examples of pathway redesign


Allied Health Professions

A diverse group of professions:PhysiotherapistsOccupational therapistsRadiographers (diagnostic radiographers and radiotherapists)Speech and language therapistsPodiatristsDietitiansProsthetists OrthotistsOrthoptistsParamedicsArt, music and drama therapists


Allied Health Professions

Autonomous practitioners with full accountability for patient care

Registered with Health and Care Professions Council

Work flexibly across organisational boundaries

Defined career pathway from practitioner to advanced practitioner

and consultant practitioner

Develop specialist skill set in response to service need

Prescribing rights for some professions

Offer first contact assessment and diagnosis through to treatment,

discharge and rehabilitation & reablement


The AHP Offer to Emergency and Urgent Care

Emergency Department: Initial assessment and diagnosis

Physiotherapy led MSK pathway Radiographer led MSK hot reporting

Lower limb vascular assessmentAdmissions avoidance

Frail elderly – links with community services and intermediate careLong term conditions management

Acute admissions unit: Increase patient flow /facilitate discharge

Community (preventing attendance/reattendance): Long Term Conditions managementFallsYoung adults and children


BenefitsIncreased patient experience – time spent in ED, number of hand offs, treatment plans, links with community services

Improved patient outcomes - quicker diagnosis and treatment

Workforce Efficiency - right person, right skills, right time Releases time for medical staff Enhanced skill mix – education of whole team

Increased patient flow – ED / acute admissions unit

Reduced admissions /readmission

Reduced attendance /re-attendance rates

Crisis prevention in mental health


ELHT Urgent Care Centre (UCC) Physiotherapy Service

Who?

Team of Physiotherapists working across two Urgent Care Centres- Royal Blackburn Hospital and Burnley General Hospital

First contact practitioner role commenced in 2011 1 Physiotherapy Team Leader, 4 WTE Senior Physiotherapists

Service Provided Assessment, investigation and treatment of musculoskeletal

presentations- sprains, strains, low back pain, neck pain, fractures Facilitation of safe discharge via mobility assessment and brief

intervention Referral to other services/ follow up therapy as indicated Referrals received from all members of MDT in and out of working hours



Why?

Approx. 38,000 patients attending with MSK presentations per year MSK accounting for approx. 1/3 of all attendances to Urgent Care Attendance figures rising yearly Appropriate knowledge and skills to assess and treat effectively Difficulties in recruiting to emergency medicine posts Increased number of permanent staff working within Urgent Care …Why not?



Benefits

Patient satisfaction and patient flow Signposting to services, patients directed along appropriate pathways of

care from initial attendance Complement traditional workforce skill set, Increased collaborative

working Work jointly with OT, hospital aftercare services Reduction in unplanned re-attendance rates Active involvement in education of staff of all disciplines Opportunities to expand skill set: wound management, burns, minor head

injury, independent prescribing



Moving forward

Working towards true 7 day services On-going development of pathways with out patient services Integrated discharge service Independent Prescribing Potential for advanced practice roles Working with focus group re: standardised outcome measures, formalised

training for ED/UCC Physiotherapy practitioners


Pennine Care Therapy Team in A+EPhysiotherapy and occupational therapy teamService operates 7 days a week 8am – 8pm in A+EProactive screening of patients in triageReferrals from wider teamAssessment of patient to identify needAdvice and treatment including provision of equipmentFacilitation of discharge (linking with Red Cross)Fast track referral to social services, intermediate care, community services, rehabilitation and reablement

Benefits 100% patient satisfaction73% deflection rateEstimated annual savings of £1.3 million


East Lancashire Falls Response Service

Paramedic and Occupational Therapy led serviceInitial paramedic assessment using pathfinder tool, following falls self- care pathwayOnce patient deemed safe and free from injuries, therapy assessment undertaken – patient and environmentalJoint assessment of balance, mobility and other clinical indicators plus functional and cognitive assessment. Intervention includes provision of equipment, referral to other healthcare professionals / agencies and information / advice.

BenefitsPilot demonstrated reduction in conveyance to hospital from 79% to 28% (7/124 required repeat call out) Estimated annual savings for reduction in attendance at ED (excluding any admission costs) = £222k


Developing the Evidence Base Necessary to support wider adoption of alternative pathways What would be useful to measure?

Number of patients seen per WTE Total time spent in department Total time to treatment Deflection ratesUnplanned reattendance rate Reduction in medical and nursing staff timeEducation of wider clinical team Patient experiencePatient outcomesStaff satisfaction Need for other treatment e.g. Medication

Identifying the required skill set and competences for the workforce


SummaryAHPs are autonomous practitioners who can lead and support alternative pathways for emergency and urgent care.

AHPs can: prevent attendance at EDs assess, treat and discharge prevent admission facilitate discharge signpost to other services and agencies

Benefits include increased quality of care and reduced costs

Stronger evidence base required to support wider adoption of such pathways


Thank You

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Healthcare

Sue Louth Gemma Aspinall- Urgent Care conference