SW Strategic Clinical Network for Maternity & Children Reducing Avoidable Unplanned Hospital Admissions Long term Conditions 14 th October 2014 Exeter Rugby Club Matthew Ellis Associate Clinical Director SW Strategic Clinical Network for Maternity & Children SCN Conference Reducing Avoidable Unplanned Hospital Admissions Long Term Conditions November 2014

CYP Priorities Working Groups Avoiding Unplanned Admissions Long Term Conditions Themes Smarter network thinking expertise earlier on pathways Integrated working (1° / 2°/ 3°, Health/CYPS) Making the Unplanned Planned Parity of Esteem

NHS Outcome Framework areas for improvement 2.3 (2) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 3 a Emergency admissions for acute conditions that should not usually require hospital admission 3.2 Emergency admissions for children with LRTI

Scale of CYP patient flow on the ’emergency/urgent care pathway’ around the South West? How big is the patient flow on the ’emergency/urgent care pathway’ around the South West >120,000 emergency department walkins involve CYP around south west annually > 18,000 GP referrals involve CYP around south west annually >120,000 emergency department walkins > 18,000 GP referrals for urgent care > 25,000 CYP assessed in specialist paediatric assessment units (SPAUs)

Big 6 (account for >50% admissions) + abdominal pain asthma/wheezy child bronchiolitis feverish illness gastroenteritis head injury + self harm (up by 68% in the last 10 years)

Variation across the Region eg Zero length of stay admissions 6Zero days admissions

Provider responses (n=10 of potential 14) Assessment Unit (SSPAU) 7 units report this provision variables where/when/who? Rapid Access Clinic 6 units report this provision Variables how often?

Complexities of Systems

Advice and Guidance 8 (of 14) hospitals consulted ‘offer’ this service 3 - Consultant, 3 – ST, 1 - SHO,1 - ED, Only 1 is formally commissioned and routinely records the activity for this service PA 20% deflection Vast majority to ‘home care’ Minority to ‘hot clinic’

“It’s Good to Talk”: Looking at the effect of a GP Phone Advice Service within a Children’s Emergency Department Dr Zoe Roberts, Dr Rosie Fish, Dr Jacqueline Seckley, Dr Will Christian Introduction The Children’s Emergency Department has seen a significant increase in yearly attendances, many of which could have been dealt with in the primary care setting. With increasing pressures on acute paediatric services, the Bristol Children’s Emergency department introduced a telephone advice line for primary care providers in April The aim is for this to be delivered by the ED consultant group in order to try and reduce unnecessary visits and support primary care providers in their clinical practice. Methods/Design A one-month pilot study was undertaken in May 2011 to inform the development of the service. Following this a further, more detailed analysis was undertaken in June 2011, looking at all phone referrals to the department. Details documented included: Following this a survey was distributed to all GPs involved in the pilot study for feedback. Results : Total of 350 calls in June (average 12 per day) Outcome of Call (by grade) Grade of person taking the call Time of call Patient demographics Referrer Reason for referral Brief history /examination findings including vital signs Agreed Plan Outcome (including advice given and disposal) Conclusion: In _ out of _ cases, the call resulted in the avoidance of a same day ED attendance. There was no obvious difference in outcome according to grade which may reflect on both the seniority of the trainees taking the call and the availability of consultant advice during the hours of 0800 – Because there is a written record of the call, the consultant / senior trainee is often more aware of the acuity presenting to the ED and in some cases this has resulted in escalation of the pre-hospital management. Whilst we are succeeding in the overall aim of reducing emergency department attendances and there appears to be support for this service from GPs, it has also brought its own challenges namely consultants being drawn away from the shop floor during our busiest times and the potential financial loss caused by the reduction in ED attendance tariffs. Therefore in order to ensure its sustainability, we need to ensure adequate consultant availability and consider the potential for financial recompense for this service.

Best Practice Network Standard Advice and guidance An 8 to 8 service for GPs to access advice and guidance from local paediatrician SEE Revised Facing Future Standards: RCPCH in consultation 2014 ‘immediate telephone advice for acute problems for all paediatricians for all specialties’

Advice and Guidance Use Network to leverage commissioned advice and guidance by paediatricians for primary care across the region in 2015 Use Network to leverage specialist advice and guidance for paediatricians by specialist paediatricians across the region in 2015

Assess what works- standardise unit metrics to allow more informed evaluation of initiatives at unit level establish the simple core data needed for evaluation of initiatives at local level using unit trend data Pilot data collection in individual units to ensure that data collection is feasible in 2014 Procede to a region wide evaluation study in 2015

Long Term Conditions 0-16 years Prevalence South West Diabetes: 2,000 Epilepsy: 8,000 Asthma: 40,000 boys 30,000 girls ‘Core’ Disability: 0-16 yrs 56, yrs 90,000 NHS

2013 commissioned review NHS /3rds of deaths in those with complex needs Half of these ie 1/3 of all deaths in children with neurodevelopmental conditions

Making the unplanned planned – Community Childrens Specialist Nursing Diabetes Nurse – HbA1C control Practice Nurse – asthma planning Epilepsy Nurse – AED compliance emergency fit control

Epilepsy 12 audit

Epilepsy12 Performance results across the South West Strategic Clinical Network

ConcluSmarter network thinking expertise earlier on pathways Integrated working (1° / 2°/ 3°, Health/CYPS) Making the Unplanned Planned sions Smarter network thinking with expertise earlier on pathways Integrated working Making the Unplanned Planned Thankyou Questions? How can you help achieve these three principles?