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How our CCG tackled unnecessary A&E attendances and saved £500,000

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By lealegraien@cogora.com
18 November 2017

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Tameside and Glossop Clinical Commissioning Group (CCG) saw an opportunity to cut its costs by reducing unnecessary Accident and Emergency (A&E) attendances.

 

The problem

Within the next 20 years, the percentage of people over the age of 85 will double nationally.

Over the last six months, 1,300 calls were made to Tameside Council’s community response team for elderly people who suffered a fall.

It costs around £500 to discard an ambulance. Multiplied against the total number of calls, the bill amounts to £600,000.

Yet, the majority of residents in local homes end up in A&E when they don’t need a hospital visit.

In a period where A&E services have come under increased pressure, our initiative is seen as a possible solution to the problem.

What we did

Through the Care Together programme, our integrated health and social care system as provided an innovative remedy.

We decided to use Skype to avoid sending out unnecessary ambulances and free up attendances at Tameside Hospital’s A&E by treating residents in their own home.

In many cases, the one-to-one advice allows incidents to be dealt with without the need for an ambulance or a GP, which helps to reduce pressures on these vital services.

However, if a hospital visit is required, the patient can be fast-tracked with the necessary medical team waiting. There is no need to go through triage or a long stay in A&E.

The pilot

When patients within care and residential homes become ill and unwell, the care providers can connect via skype to the digital health service.

A dedicated registered nurse at the trust will then ask a list of questions, do an assessment based on observations and give expert advice and guidance. Observations can include blood pressure readings and monitoring of heart rate, among others.

The scheme was initially piloted in four care homes in Tameside, in March 2017. It has now been rolled out to 40 homes across Tameside and Glossop, not including our community response patients.

We currently assess patients in their place of residence and direct services to the patients, including GPs community nursing teams, the wider multidisciplinary team (MDT) and voluntary services.

We have worked collaboratively since May 2017 with our Community Response Service (CRS), who have the tablet devices on a 4G plan and can Skype people in their own homes into the service.

We operate from Monday to Friday, 8am to 10pm and from 8am to 6pm on Saturday and Sunday.

The pilot comprisesfive nurses and myself, as the clinical nurse lead for the service. We have another two part-time nurses joining our team in the next few weeks.

Results

Since the iPads came into use, only five of 15 call-outs have resulted in hospital attendance.

In addition to this, the community response team has its own lifting equipment. Consequently, the 1,200 falls occurring in a period of six months led to only 93 ambulance call-outs, which equates to a saving of around £500,000.

To date we have received 1300 calls and avoided 800 unnecessary A&E attendances.

Some homes were struggling to get GPs to come or talk to, especially late during the day, which resulted in them saying to dial 999.

It resulted in the ambulance crew spending hours at the care home and if they did take the patient to the hospital, the difficulty was to send along a member of staff to accompany them. It is especially difficult for a resident who has got dementia to spend hours in A&E.

As an example of success story, our digital centre helped stop a 100% of Bourne House residential care residents going into hospital.

The future

TheIntegrated Care Organisation (ICO) has invested financially – and we have the full support and backing of our executive team and partners – to integrate other services into our digital health team, for example our GP call handling systems and the long-term conditions monitoring systems.

The Direct health (DH) service being a mandatory part of the homes contract, the CCG is looking at standardising care across the health care economy.

Recent conversations and schemes that are taking place in line with the development of ICO have indicated that the CCG will help deliver higher standards of patient focused care.

This will be achieved by support and education for care staff and support for homes that are not meeting all the standards of care set out by the Clinical Quality Commission (CQC) and the care commissioners.

We are in conversation with our North West Ambulance Service (NWAS) colleagues looking at how we can support the ambulance service in the future.

We are also planning to recruit a further five care homes within Tameside and Glossop and in the process of recruiting more team members to extend the service overnight.

CCG comment

The idea behind this service is two-fold. Primarily we don’t want residents in care homes coming to A&E if they don’t really need to. Secondly, it frees up the time in the A&E department to see those patients most in need of emergency care.

‘We are immensely proud of our achievements to date and have had some real success stories with our integrated working.’

Peter Grace is the clinical nurse lead for digital health at Tameside and Glossop CCG

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