Urgent Care Planning in South Tyneside

David Hambleton

Urgent Care Everyone’s problem

Urgent Care Plans

• Urgent Care – – Everyone’s problem so nobody’s problem • Why is it a problem – High A&E attendances but – Low admission rates – Lots of people in A&E who needn’t be

Percentage of A&E Attendances converting to Admissions

3

Over-crowding in A&E

W

hy it’s a very bad thing

• After admission through a crowded A&E

43%

increased chance of dying at 10 days • A&E stay of 4-8 hours increases inpatient length of stay by 1.3 days • A&E stay >12 hours increases inpatient length of stay by 2.35 days

What can be done prior to A&E

• GP Access • Quality Premium (GP QOF) – Ambulatory Care Conditions – A&E usage • Anticipating urgent care demand • Improved care in nursing homes • STICS - better management of LTC • RAID - rapid, effective and safe access to mental health services

What can be done in hospital

• Ambulatory Care Conditions pathway • GP in A&E?

• White board system to track patients • Review spilt of beds between medical and surgical specialties • Rapid response clinics • Psychological liaison service within an Urgent Care hub

Discharge & out of hospital care

• Hospital discharge process and communication • ‘Time to think’ beds • Single point of contact for social care • Reviewing current provision of self management education and support

NHS 111 update

• National free-to-call memorable number • Single point of contact for urgent care • ‘Talk before you walk’ • NE system is working (unlike others) • Teething problem being ironed out • Opportunities still to be realised

NHS 111 update

• Patients directed to right services, first time • Directly booking appointments into services – including GPs • Better use of community services • Indentify where gaps in service are

DRAFT URGENT CARE SYSTEM MAP – South Tyneside Urgent Care Delivery Group Self Care Supporting older people at home Crisis Acute setting Step down Supporting older people at home Self Care

•

STICS (COPD) *Primary care

•

STICS (COPD)

•

Nursing home SLA/ LES

•

Community matron as care coordinator (evaluation)

•

Telehealth/ wound sense

•

DNs/ flu vaccines

•

Zoning of Urgent Care nursing teams

•

ACS Pathway review

•

Single point of contact social care

•

IRT

•

Discharge process

•

Discharge Communication

•

PPP patients

•

Time To Think beds

•

Dementia Step up facilities

•

Perth Green Shared Care Plans *Primary Care *Community nurses (map which teams) *A&E *Local Authority *Community nurses (map teams) * Hospital staff * SW team * LA * FT

•

STICS (COPD)

•

Nursing Home SLA/ Spec

•

Pulmonary Rehab

•

Cardiac Rehab *Primary Care *Community Nurses (map which teams)

•

Pulmonary Rehab

•

Cardiac rehab *Rehab teams Tools Risk stratification

- (in use in a fragmented way, i.e. separately in FT and Primary Care); not yet in use in LA = opportunity to streamline, agree consistent cohort? e.g. at risk of admission

Standard Care Plan

– opportunity

Standard work

– across the pathway for this group involving teams and shared understanding, + time based standards = opportunity (see Nottinghamshire work in progress on frail elderly pathway care standards)

Round Table Discussion

• On your tables you will be asked to consider: • Are we on the right lines with our plans? • What else should we be thinking about doing?