rakesh marwaha & ian hays: urgent care in derby
TRANSCRIPT
Urgent Care in June
2010Derby 2010R k h M hRakesh Marwaha Director of Performance and Knowledge Management
Ian HaysSenior Knowledge Officerg
Contents
About Derby About Derby
The Problem
Evidence Gathering
Actions / OutputsActions / Outputs
Summary
About NHS Derby City
Integrated organisation since 2004
Population served c291,000 (census c243,000)
Resource allocation c £447m Resource allocation c £447m
HCC results Good for quality, Good for use of resources
69th most deprived local authority out of 354 Significant internal variance: Derby contains Lower Level S O t t A li t d i b th th t d i d 20%Super Output Areas listed in both the most deprived 20% and the most affluent 20% in England
About NHS Derby City
Contents
About Derby About Derby
The Problem
Evidence Gathering
Actions / OutputsActions / Outputs
Summary
The Size of the Problem
3600082000
Emerge
ndan
ces
Non Elective Admissions and A&E Attendance Trends
2009/10 -£1730
Cost per Non Elective Admission
33000
34000
35000
76000
78000
80000
ency Adm
issions
A&
E A
tten £1730
31000
32000
70000
72000
74000
s
2008/09 -£1510
28000
29000
30000
64000
66000
68000
Annual A&E Figures Annual NEL Adms
2007/08 -£1500
Tota
l Cos
t2005/06 2006/07 2007/08 2008/09 2009/10
12.5% growth in A&E Attendances in last five years
14% growth in emergency admissions in last five years
Total Activity
Significant increase in cost per patient for non
elective admissions due to tariff price change HRG 14% growth in emergency admissions in last five years elective admissions due to tariff price change, HRG
4 and Length of Stay costs
PCT i E t Midl d
The Size of the Problem ‐ ComparatorPCT in East Midlands peer group
128128
124123
116PCT 2PCT 3PCT 4PCT 5
PCT 1
Non‐ elective d i i hi h
213174
148129128PCT 5
PCT 6PCT 7Derby CityPCT 9
+22%
admissions are high compared to peers and benchmarks
PCT in ONS peer group
Ø 143
138PCT 1
161154
152151149
138
PCT 5 PCT 6 PCT 7
PCT 2
PCT 4PCT 3
Non‐elective admissions per 1,000 weighted population, 2008/09
174Derby
174174
163162161
Derby CityPCT 10
PCT 7 PVT 8PCT 9
+12%154
136
ONS
East Midlands
7
Ø 156
SOURCE: Dr Fosters data 2008/09; 2007 weighted pops ONS, Business Intelligence Unit
Contents
About Derby About Derby
The Problem
Evidence Gathering
Actions / OutputsActions / Outputs
Summary
Examining Urgent Care
Where
When
Who
How
Why ?
Examining Urgent Care – GP Audit
One area identified of particular concern was theparticular concern was the rise in conversion rate from A&E attendances to emergency admissionsemergency admissions
GP Audit was carried out to check validity of GP direct admissions
Findings: The GP Audit of Emergency Admissions carried out in March 2009 found that of 378 recorded admissions 70 (19%) were assessed as avoidable *that of 378 recorded admissions, 70 (19%) were assessed as avoidable.*
*Performance and Knowledge Management Directorate (2009) GP Audit of Emergency Admissions Derby Hospitals Foundation Trust
Examining Urgent Care ‐MCAP
Resource Utilisation (Bed Census) Audit
A panel of nurse reviewers used the Oak Group Criteria to review :
i. all non‐elective patients admitted between 16‐22 August 2009
ii all patients in a care bed ith an in hospital length of sta of fi e da s or moreii. all patients in a care bed with an in‐hospital length of stay of five days or more.
Examining Urgent Care ‐MCAP
Resource Utilisation (Bed Census) Audit
A panel of nurse reviewers used the Oak Group Criteria to review :
i. all non‐elective patients admitted between 16‐22 August 2009
ii all patients in a care bed ith an in hospital length of sta of fi e da s or moreii. all patients in a care bed with an in‐hospital length of stay of five days or more.
25% (16) were assessed 34% of patients with a stay of five25% (16) were assessed as not qualifying for an acute admission
34% of patients with a stay of five days or more were assessed as not qualifying for such a stay
Between 44% ‐ 63% of acute bed days are
29% of all non‐elective bed days in Derby are within Medicine for the acute bed days are
inappropriate (UK studies)Derby are within Medicine for the Elderly
Contents
About Derby About Derby
The Problem
Evidence Gathering
Actions / OutputsActions / Outputs
Summary
Current Status
Rightcare – over 400 patients registered ££savedS i Rightcare over 400 patients registered, ££saved 100% of Practices extended hours Social Marketing – Outreach team
Service
Avoidance
Service Navigation ‐ 4 diverts/day, ££h h h l d
Admission IV Therapy, DVT & Catheter ‐ ££cash releasedMAU Triage – New clinical model implementedAvoidance
Transitional Beds = 510 Emergency & 3129 rehab bed days saved Early supported discharge – ££saved
Community y pp g
Continuing Care costs falling in opposition to other East Mids PCTs
Service
Contents
About Derby About Derby
The Problem
Evidence Gathering
Actions / OutputsActions / Outputs
Summary
Tier 3 Service
Tier 1 ServiceTier 2 ServiceSummary
Primary Care
Tier 4 Service
Referra
10 Point Plan
EXPANDED AND ENHANCED
ACUTE HOSPITALService Navigation Team –earlier discharge (MCAP audit A&E, Mental Health, Social, Intermediate & Continuing Care, Voluntary Sector)
l Managem
en
10 Point Plan Primary Care Foundation
RightCare
L T C di i COMMUNITY SERVICES
HOME
Enhanced Step Up/Down & Comm Intermediate Care Services
t / Follow Up
Long Term Conditions
Referral admissions standardisation
Service Navigation (phase 2)
Staying Healthy
New model for ACS conditions –earlier discharge
EMAS DEMAND
DHFT Review MAU(CDU)
SELF CAREDischarge Planning
Improved resource Utilisation
p
Walk In Centre Review
Expert Patient Programme
Health Coaching
RightCare
Duty Doctor
Social Marketing Campaign
Rapid 1 hr Community Response team New Patient flow team
MANAGEMENT
Care of the ElderlyFalls StrokeWelcome Pack for New Entrants
Respiratory pathway
IV therapies service
Evening suspected DVT service
Care of the Elderly Physician in A&E/MAU
Contracting
Falls, Stroke, Trauma, Alcohol
Catheter service pathway
INTEGRATED CARE MODEL
Transitional / Intermediate Care
Summary
Problem
14% growth in admissions
5% increase in activity with 19% rise in cost (Tariff cost, HRG4 and LOS)
E id Evidence
Systematic and triangulated evidence gathering from external audits
Benchmarkingg
Actions
Defining Knowledge reports to Board
Plans, implement, robustly performance manage, continuously improve
Robust transformation and contract management with providers
Outputs Outputs
££savings delivered to date with On Target Savings of ££savings
QUESTIONSQUESTIONS