Transcript The Role of Virtual Wards in Reducing Unplanned Admissions

The Role of Virtual
Wards in Reducing
Unplanned Admissions
Maggie Ioannou MSc BA RGN RSCN RHV
Director of Community Health Services
Croydon PCT
Identifying Patients
Key to success is in accurate identification
of patients
• Clinician referrals do not work
• Threshold modelling (e.g. all patients aged
>65 with 2+ admissions) do not work
Average number of emergency bed days
Regression to the mean
50
45
40
35
30
25
20
15
10
5
0
-5
-4
-3
-2
-1
Intense
year
+1
+2
+3
+4
Emerging Risk
Average number of emergency bed days
50
45
40
35
30
25
20
15
10
5
0
-5
-4
-3
-2
-1
Intense
year
+1
+2
+3
+4
Predictive Risk Modelling
• Kaiser Permanente and other US
providers have been using this method
successfully for 20 years
• Their algorithms are proprietorial
• NHS commissioned its own algorithms
which can be downloaded free of charge
by PCTs
In-patient
data
Outpatient
data
A&E data
GP
Practice
data
Combined
Model
Intervention
Social
Services
data
Intervention
10 Croydon Virtual
Wards
• Croydon population
= 340,000
• 10 virtual wards
– Catchment population of 34,000
residents per ward
– One ward per 15 GPs
• 100 “beds” per ward
Virtual Wards
• Mimic hospital ward
• Patients cared for in their own homes
• No physical ward building, hence the term virtual
wards
• Patients case managed by multidisciplinary team
• Ward Team headed by Community Matron
Virtual Ward A
GP Practice 1
GP Practice 2
GP Practice 3
GP
Practice 4
Virtual Ward B
GP Practice 5
GP
Practice 6
GP
Practice 7
Community Matron
Nursing complement
Health Visitor
Ward Clerk
Pharmacist
Social Worker
Physiotherapist
Occupational Therapist
Mental Health Link
Voluntary Sector Helper
GP
Practice
8
Community Matron
Nursing complement
Health Visitor
Ward Clerk
Pharmacist
Social Worker
Physiotherapist
Occupational Therapist
Mental Health Link
Voluntary Sector Helper
Specialist Staff
•Specialist nurses
•Asthma
•Continence
•Heart Failure
•etc.
•Palliative care
team
•Alcohol service
•Dietician
Medical Input
• Community matron given the bypass
telephone number to the duty doctor at each
of the constituent GP practices
• Community matron able to book appointments
to see the patient’s usual doctor
Croydon
Expert
Intermediate
Patients’
Care
Programme
Service
“Daily”
“Weekly”
“Monthly”
5 Patients
35 Patients
60 Patients
Discharge
100 patients per ward
“Daily”
“Weekly”
“Monthly”
5 Patients
35 Patients
60 Patients
5
(35  5)
(60  20)
= 5+7+3
= 15 patients for discussion each day
PREDICTED
0
PARR Score
98 100
OBSERVED
0
PARR Score
98 100
Key Strengths
• Patients identified according to predicted need
thereby reduces health inequalities and counters
the inverse-care law
• Multidisciplinary, multi-sector partnership
• Eliminates duplication
• Patient-focused
• Simple intervention that is being adopted across
the UK
Lessons learnt so far 1
• Wards must make sense to primary care
teams
• Takes time to integrate social care
• Issues of confidentiality must be faced
early
• Impact across whole system is dynamic –
in particular community nursing
• Takes time to keep acute trust on board
and not antagonistic
More lessons
• Do not underestimate change
management demands
• Trying to map savings across HRG groups
is very complicated
• Important to remember that savings are
whole system not attributable to one
intervention
• Public relations crucial
• The price of winning awards!
What makes the partnership work
• Genuine trust and respect
• Shared vision that unplanned admissions are
frequently avoidable
• Communication at all levels
• Sharing success; creating solutions together
• Facing the difficult issues in an open manner –
brush nothing under the carpet
• Leadership
• “Can do” environment