SW Strategic Clinical Network for Maternity & Children - PowerPoint Presentation

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SW Strategic Clinical Network for Maternity & Children

Reducing Avoidable Unplanned Hospital AdmissionsLong term Conditions14th October 2014 Exeter Rugby ClubMatthew Ellis Associate Clinical Director

SW Strategic Clinical Network for Maternity & Children

SCN Conference

Reducing Avoidable Unplanned Hospital Admissions

Long Term Conditions

November 2014Slide2

CYP Priorities Working GroupsAvoiding Unplanned Admissions

Long Term ConditionsThemesSmarter network thinking expertise earlier on pathwaysIntegrated working

(1° / 2°/ 3°, Health/CYPS)

Making the Unplanned PlannedParity of EsteemSlide3

NHS Outcome Framework areas for improvement2.3 (2) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s3 a Emergency admissions for acute conditions that should not usually require hospital admission3.2 Emergency admissions for children with LRTISlide4

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)Slide5

Big 6 (account for >50% admissions) +abdominal painasthma/wheezy child bronchiolitis feverish illness gastroenteritis

head injury + self harm (up by 68% in the last 10 years)Slide6

Variation across the Regioneg Zero length of stay admissions

6Zero days admissions Slide7

Provider responses (n=10 of potential 14)Assessment Unit (SSPAU)7 units report this provision 

variables where/when/who?Rapid Access Clinic6 units report this provisionVariables how often?Slide8
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Complexities of SystemsSlide10

Advice and Guidance8 (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 serviceCommissioned @£100k PA20% deflection

Vast majority to ‘home care’Minority to ‘hot clinic’Slide11

“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 2012. 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 – 22.30. 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.Slide12

Best Practice Network Standard Advice and guidanceAn 8 to 8 service for GPs

to access advice and guidance from local paediatricianSEE Revised Facing Future Standards: RCPCH in consultation 2014 ‘immediate telephone advice for acute problems for all paediatricians for all specialties’Slide13

Advice and GuidanceUse Network to leverage commissioned advice and guidance by paediatricians for primary care across the region in 2015Use Network to leverage specialist advice and guidance for paediatricians by specialist paediatricians across the region in 2015Slide14

Assess what works-standardise unit metricsto allow more informed evaluation of initiatives at unit levelestablish 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 2014Procede to a region wide evaluation study in 2015Slide15

Long Term Conditions 0-16 years Prevalence South WestDiabetes: 2,000Epilepsy: 8,000

Asthma: 40,000 boys 30,000 girls‘Core’ Disability: 0-16 yrs 56,000 0-25 yrs 90,000NHS 2013

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2013 commissioned review 1990-201316

NHS 2013

2/3rds of deaths in those with complex needs

Half of these

ie 1/3 of all deaths in children with neurodevelopmental conditionsSlide17

Making the unplanned planned –Community Childrens Specialist NursingDiabetes Nurse – HbA1C control

Practice Nurse – asthma planningEpilepsy Nurse – AED complianceemergency fit controlSlide18

Epilepsy 12 auditSlide19

Epilepsy12 Performance results across the South West Strategic Clinical NetworkSlide20

ConcluSmarter network thinking expertise earlier on pathwaysIntegrated working (1° / 2°/ 3°, Health/CYPS)Making the Unplanned Plannedsions

Smarter network thinking with expertise earlier on pathwaysIntegrated working

Making the Unplanned Planned

ThankyouQuestions?

How can you help achieve these three principles?