Transcript Urgent-Care-Presentation-LEB-11-July-13
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
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STICS (COPD) *Primary care
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STICS (COPD)
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Nursing home SLA/ LES
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Community matron as care coordinator (evaluation)
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Telehealth/ wound sense
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DNs/ flu vaccines
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Zoning of Urgent Care nursing teams
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ACS Pathway review
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Single point of contact social care
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IRT
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Discharge process
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Discharge Communication
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PPP patients
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Time To Think beds
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Dementia Step up facilities
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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
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STICS (COPD)
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Nursing Home SLA/ Spec
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Pulmonary Rehab
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Cardiac Rehab *Primary Care *Community Nurses (map which teams)
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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?