Reducing hospital admissions Improving care for people with dementia.

Slides:



Advertisements
Similar presentations
The Balance of Care Group Alternatives to Hospital MODELS OF INTEGRATED CARE Tom Bowen ORAHS 2008, Toronto, 29 July.
Advertisements

Implementing the Stroke Palliative Approach Pathway
Older People with Dementia in Acute Care: K ey messages from the NAO report Paul Forte The Balance of Care Group
GOLD STANDARDS FRAMEWORK
Welcome to the new acute and community County Durham and Darlington NHS Foundation Trust Clinical strategy FT member events April 2011.
Northern Trust Nursing Home Outreach Project
Rapid Admission of Palliative Patients. Hospital Macmillan Specialist Palliative Care Nurse. Lung Cancer Specialist Palliative Care Nurse. September 2008.
SAFER Patient Flow Bundle The patient flow bundle is similar to a clinical care bundle. It is a combined set of simple rules for adult inpatient wards.
2012 UPDATE. What guidelines do we have available to follow for asthma 1) Asthma GP monitoring Guideline 2) Asthma Diagnosis Guideline 3) Acute asthma.
To eliminate unnecessary delays in the safe transfer of care of patients from acute therapy teams to community services by improving the quality of information.
Integrated Services Dr Steve Cartwright – Clinical Executive for Integration and Partnerships Andrew Hindle - Commissioning Manager for Integration.
1 Developments and progress Dr Martin Freeman GP Clinical Lead for Dementia Services.
The main drivers Compassion - Compassion is the emotion that one feels in response to the suffering of others that motivates a desire to help Dignity.
Baseline Model of care for proposed community wards Appendix 1.
Method Cycle 1 : Retrospective case notes analysis of the last 40 patients on the Kingston Hospital Palliative Care Register on a single Care-of-the-Elderly.
JSNA Schizophrenia progress report Martina Pickin Locum Consultant in Public Health.
Adult Hospital at Home Service Sue Gibbs 27 th March 2014.
Powys-wide, Primary care audit Rhiannon Davies, Powys tHB Medicines Management Team Prescribing of Antipsychotic Medication in Patients with Dementia.
The Liverpool Care Pathway Dr Kate Tredgett, Consultant in Palliative Medicine.
Right First Time: Update. Overview Making sure Sheffield residents continue to get the best possible health services is the aim of a new partnership between.
Ideas from UK modernisation: The Improvement Partnership for Hospitals Penny Pereira Ideas from UK modernisation.
Hospital Admissions Andy Sharp, Service Director – Adult Social Care Tim Branson, Service Manager - Enablement.
National rapid access to best-quality stroke services Prevent 1 stroke every day Avoid death or dependence in 1 patient every day National Stroke Clinical.
IMPs – Intermediate Mental & Physical Health Care Team
Patient Empowerment in Chronic Obstructive Pulmonary Disease (COPD) Noreen Baxter Respiratory Nurse Specialist May 2005.
NCEPOD Report Caring to the end? Issues for physicians Prof IT Gilmore PRCP.
Dignity in Care INTEGRATED CARE PATHWAY FOR THE ADULT DYING PATIENT IN CARE HOMES Julie Williams Macmillan Nurse Specialist for Palliative Care Education.
Sasha Karakusevic. We have achieved substantial improvements for our community and receive positive feedback from patients and the public Both the Care.
Service 19 TH JUNE 2014 /// SEPTEMBER 4, 2015 ALISON CLEMENTS.
Scottish Antimicrobial Pharmacist Group SNAP-CAP& Empirical Prescribing Indicator Audit 8 th June 2010.
Challenges in dementia provision – a service that can support you Sandra Bailey RMN, BSc, Ma, Independent Non-Medical Prescriber Team Leader DIST.
Satbinder Sanghera, Director of Partnerships and Governance
Nurse-led Long term Conditions Management
GP Perspectives on the Home Based Crisis Team. City North Sectors, Cork. Muller Neff, D., O’Brien S.M. ABSTRACT: OBJECTIVES: The introduction of crisis.
Commissioning alternatives to hospital Dr Seth Rankin Rob Persey.
Changing Practice in Nursing and Care Homes National Dementia Learning Event 29 th September 2011 Jillian Torrens, Adult Services Manager, Glasgow CHP.
Management of Adults with Diabetes undergoing Surgery and Elective Procedures UHL Guideline – April 2013 The aim of the guideline is to improve standards.
The PAN-Care Project Development and testing of a comprehensive care planning service to enable patients with end stage pancreatic cancer die at home Department.
Planning David Bonson April March-May We are here Final draft of plan.
A systematic approach to dealing with cancer related emergencies (Acute Oncology) Jackie Tritton Nurse Director Mount Vernon Cancer Network. YALE International.
Community Nurse In-reach (CNIR) Providing safe & effective nursing discharges across the Hospital & Community Interface.
The Role Of The Dementia Care Home Liaison Nurse Within South East Essex Jackie Smith Clinical Nurse Specialist Dementia Care Home Liaison Nurse.
A Regional Approach to Improvement Julie Branter Associate Director for Clinical Governance and Patient Safety 21 September 2010 South West Strategic Health.
PRIMARY CARE CONTRACT NURSING & RESIDENTIAL CARE HOMES Right place, Right time, by the Right person Shivaun Aveston, Transformation Lead.
The London Pathway Homeless Team at UCLH Brief Update 2010.
The Health Roundtable Central Network Respiratory Coordinated Care Program Innovation Presenter: Benjamin Kwan Staff specialist respiratory and sleep medicine.
Reflecting on the presentations: Share experiences from your own Health Board area / locality / site in relation to the part of the patients’ flow discussed:
National Audit of Dementia – care in general hospitals National Audit of Dementia Royal College of Psychiatrists Centre for Quality Improvement 4 th Floor.
Frail Elderly Pathway Walsall Healthcare NHS Trust.
Improving general hospital care for people with dementia: why, how and with whom? Nye Harries DH SW.
Counting the cost Caring for people with dementia on hospital wards.
Impact of: a specialist wound clinic on patients who develop complex wounds post cardiac surgery Presented by: Penny Gowland ANP Pascaline Njoki Thanks.
Emergency Access Information Network - May 2009 ‘Why do people attend’ NHS Forth Valley A&E and what do we need to do to better manage demand’ Kathleen.
The Health Roundtable Improving the patient journey through ED Presenter: Kate Jurd Health Service: Toowoomba Hospital Innovation Poster Session HRT1215.
A Musculoskeletal Pathway Sarah L Mitchell, Rehabilitation Programme Manager, Scottish Government June Wylie, AHP Professional Officer, Scottish Government.
Long Term Conditions Strategy There are 3 key aims to our improvement strategy: WHCCG has already achieved: – Commissioned Diabetes education through the.
Level 6 Discharges from Bradford Teaching Hospitals: Destination and Survival Dr Kath Lambert SpR in Palliative Medicine BRI.
Planned Care RSCH Planned care referrals on plan for first three months Referral support service Generic Referrals Totally Health Integrated Respiratory.
Best Practice in End of Life Care:
12 March 2009 Dr Brian Montgomery Associate Medical Director NHS Lothian Emergency Access Delivery Team.
Medway Care Home Team Dr Sanjay Suman – Consultant Geriatrician - Medway Foundation Trust Prina Sahdev – Care Homes Pharmacist - Medway CCG.
NHS West Kent Clinical Commissioning Group West Kent Urgent Care DRAFT Strategy Delivering a safe and sustainable urgent care system by
E n h a n c e d h e a l t h i n c a r e h o m e s Rachel Binks, Nurse Consultant - Acute and Digital Care Airedale NHSFT The Art of the Possible - Enabling.
Integrated CQUIN 2013/2014 Suggested Impact and Measures.
ACCESS TO PALLIATIVE CARE FOR UPPER GI CANCER PATIENTS A SURVEY OF 5 CANCER NETWORKS DR Bailey 1 C Wood 2 and M Goodman 3.
JUST GIVE IT: a 2 phase study to audit the Immediate Management of Patients with Proven or Suspected Neutropenic Sepsis by Ally Gruber Acute Oncology Clinical.
Development of a Community Stroke Rehabilitation Team “meeting the need” NHS Blackburn with Darwen Tracy Walker Team Leader.
The Enhanced Continence Project – In Practice Tina Bryant – Operations Manager Sarah Thompson – Community Nurse Specialist.
- bringing health and social care together
Dementia: Barriers to accessing quality End of Life Care and Role of Admiral Nurses Chris O’Connor Consultant Admiral Nurse Dementia Fellow   
Presentation transcript:

Reducing hospital admissions Improving care for people with dementia

QIPP Principles Whole health and social care economies Teams include patients, social care, community services, AHP’s, general practices and secondary care clinicians 20% reduction in unscheduled admissions 25% reduction in length of stay Reduction in readmission within 30 days

Cornwall background The prevalence of dementia increases markedly with age and in the UK it is estimated that some 750,000 people have dementia. In Cornwall public health epidemiological data suggests anticipated prevalence of dementia is 8536 however only 3752 of people with dementia recorded on GP QOF registers (March -11).

Care homes admissions RCHT Total number of admissions 2009: 1654 Total number of admissions 2010: calls Jan

More than 4 campaign Identify reasons for admissions, Training needs analysis Implement training Join up systems and intelligence, Enhance and improve patient care.

Impact on clinical quality Joined up intelligence Educated and supported workforce Develop what to do if flow chart for common conditions. Awareness of disease pathology When to call the GP Simple nursing care procedures Improved patient care in the right place at the right time Safe and appropriate care to meet individual needs Reduction inappropriate prescribing Reduction anti psychotics Reduction in falls Tele-health implementation Better end of life care Better pain control and assessment. Access to specialist clinicians and services :

More than 4 Nursing care home admissions audit Monthly Case note review more than 4 admissions Data collection End of life dementia pilot Care home survey Amp Tele-health

Care home questionnaire The rationale for a countywide care home questionnaire and a review of services, was to report ‘thematically’ on the effectiveness of the current services, potential gaps and suggest improvements from the care home staff perspective. The review made use of 30-minute telephone interviews with care home professionals (n=27) from high and low admitting care homes.

Common themes Low admitting care homes: 1-2 GP Practice per home Regular ward rounds and review (many on a weekly basis). Combination of RMN and RGN nursing staff District nurse in-reach

Support to care homes can be split into three main areas Medical and pharmacist support Community service support Training and education

Support (continued) Service directory for care homes 1-2 (max) GP practice per care home End of life pathway for dementia Dementia training for some GPs especially medication management District nurse and /or Community matron input and support Someone to call just to talk things through rather than call 999 Serco first, Responsive community mental health teams.

Care home audit 2009

Aim Audit : To identify the numbers of patients admitted from nursing homes with a view to: 1. Identifying the appropriateness of admission i.e. those requiring acute care (whether there is an alternative to admission to hospital). 2. Determining a care pathway to prevent unnecessary admission 3. Facilitating the patient illness journey in the best setting for the individual. 4. Considering the potential cost implications of inappropriate acute admissions of people with dementia

Methodology A case note audit of patients with known diagnosis of dementia admitted into an acute district hospital (Royal Cornwall Hospital) from registered nursing care homes in Cornwall. The patient cohort identified using monthly admission figures provided by the NHSCIO Review of medical records in conjunction with a written proforma.

Key areas for scrutiny included: 1. Source of referral i.e. A&E or via GP 2. Involvement of GP prior to admission 3. Hour of admission 4. Reason for admission / Diagnoses 5. Length of stay 6. Place of discharge (final outcome) 7. Alternative treatment options 8. Cost implications around end of life care and admissions

Results n221 case notes were reviewed The total number of admissions from nursing homes to Royal Cornwall Hospital during 2009 was 534. Only those with a known diagnosis of dementia were included. Exclusions included those attending Accident and Emergency Dept. but not admitted, and those attending for elective surgery. The median age for participants was 81 (range ).

Source of Referrals The number of patients referred by GP was 90 (41%), 131 (59%) were admitted via emergency 999 service;

Break down of 999 emergency admissions

999 admissions 131 were admitted via 999 paramedic/ambulance services. 28 were appropriate (103 alternative options to hospital admission could have been offered. 97 admitted during standard working hours In total study (n221); 71 were admitted for end of life care (palliative) of whom 59 (83%) were admitted via 999 services and 19 patients (27%) were admitted out of standard working hours.

GP Involvement 54% required acute care.

Reasons for Admission to RCH Medical ConditionsNumber of patients (n221) Percentage % Infection LRTI UTI Other(ulcers/gangrene, meningitis) Falls Fracture No fracture Cardiac (MI,ACS,AF,CCF)167.3 Stroke146.3 Breathlessness and fatigue115.2

The majority of admissions were via medicine (n195 ; 90%), the rest were a mixture of orthopaedics (n11 ; 4%) and surgery (n15 ;6%). 59% (n130) patients who were admitted to RCHT during this 11 month period did not require acute care –98 (44%) admitted via 999 services. 8 (7%) required step up care and 71 (57%) were palliative, therefore there were 41 other individuals who may have received care at home thus avoiding admission 28 of whom were 999 admissions.

Final Outcome (Discharge or Death). 70% of patients were discharged back to their original nursing home, 4% were discharged to a step up care and 26% died in hospital.

Outcomes and Alternative Options Alternative treatment option Number of patients Antibiotics25 Intravenous fluids4 Bowel /bladder care4 Pain management7 Stroke/TIA (in severe dementia) – no intervention 4 Falls prevention10 End of Life care plan67 Step up – place direct from community 9 Total130 (59%)

End of Life Care In relation to those patients with advanced terminal phase dementia, 71 (32%) were palliative. Died in Hospital 58 (81 % of EoL subgroup) Transferred back to Home13 (19% of EoL subgroup )

EoL Costing ( based of non elective national tariff) Total £ (over 11 months) (Mean £ ) Mean cost per person admitted for Eol care £ ( £ cc). The above is based on PbR Tariff for – these figures were used to help quantify costing in real time.

Implications for Practice and Recommendations Identifying End stage Dementia There is a clear need to identify those with advanced terminal dementia within their care setting and instigate plans for care that are anticipatory, respectful of best interest and advocacy, appropriate to meet the needs of the individual client.

End of Life Planning End of life planning / care pathways prevent unnecessary admission to acute care and enhance the delivery of palliative care for this client group in the care home setting.

End stage dementia Pilot What is End stage dementia End of life dementia pilot Education to staff and carers Pathway Best Interest document (front notes flag to Oohrs) Allow a natural death

Response so far Over 300 patients 7 x care homes All GPs signed up Out of hours 999 Relatives feedback positive People dying in own care home and less admissions before death

?