Safely Reducing Avoidable Conveyance Programme

Direct Access to Frailty Unit (Dewsbury Acute Care of the Elderly) – Mid Yorks Hospitals

Brief Description of Initiative

Access to acute care of the elderly ward for YAS crews transporting a frail patient to hospital, avoiding long waits in ED and receiving care at a hospital closer to home.

Date Initiative was introduced in Trust

21st October 2018.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

Since reconfiguration of services in Mid Yorks hospitals (Dewsbury and Pinderfields) more patients are taken by YAS crews to Pinderfields ED, rather than to Dewsbury. The YAS Clinical Pathways Team was approached by Mid Yorks Trust to look at how patients could be better seen and treated closer to home. This initial focus has been around frail and elderly patients with a Rockwood score of 5 or more, as a need to improve access to assessment and treatment for this patient group had been identified.

Which specific patient group or presenting need is this response targeted at?

Frail patients, medical need for admission to hospital, Rockwood score of 5 or more, aged over 65.

Geographical area or location covered by this response model

Dewsbury area of Mid Yorks (urban).

Key Aims
  • Improve time to CGA
  • Reduce LOS
  • Improve patient experience and outcomes
Benefits for Patients
  • Care closer to home
  • Reducing long and often detrimental waits in ED
  • Improved time to assessment and subsequent treatment
Benefits for Trust or System
  • Patients conveyed to closer hospital, reducing travel time for crews
  • Timely handover to the unit, reducing long handover delays at ED
  • Reducing need for secondary transfers of patients back to the most appropriate hospital
Implementation

1.     How long has this initiative been operational?

Since 21/10/2018, 12 months to date

2.     Days / Hours of operation:

0800-2000 Mon-Fri

0800-1600 Sat and Sun

3.     Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

All YAS clinicians as per normal duties

4.     Which other partners are involved in providing the response?

REACT team – Community Frailty Team

Mid Yorks Trust, including Geriatric consultants, Nurses

LOCALA – local community provision

5.     What other key resources are needed for this response to work? (vehicles, specific equipment etc)

Clinical Pathways lead to work with Trust to review and audit the pathway as part of core duties

6.     How is the initiative funded? (level of engagement/support from CCGs etc)

No funding required, service in existence within the acute hospitals already.

7.     What were the main facilitators / blockers / interdependencies when introducing this response?

Collaborative working across organisations. Good admin support to help with audit and review. Some focused time from Clinical Pathways Lead and clinicians from Mid Yorks Trust to promote this pathway with frontline crews.

Evaluation & Monitoring

1.     What are the key success measures?

  • Reduction in readmission rates
  • Length of stay
  • Improving patient experience

2.     How are these being measured / collated / monitored? (frequency / who reported to etc)

KPI’s monitored by Mid Yorks Trust and reported at monthly and now quarterly review meetings – with all stakeholders involved.

3.     Has a formal evaluation process been undertaken (independent / in-house)?

A nine month in-house evaluation has taken place – see attached.

4.     What are the current findings in terms of the success measures?

  • The average number of patients per week was 5 patients.
  • The majority of patients who accessed the pathway were female (63%).
  • The majority of patients that accessed the pathway were aged 75 years or older (94%), with 57% being over 85 years old.
  • The majority of patients had a 1-day LoS (56%).
  • Only 3% of patients stayed longer than 72 hours on the DACE unit.
  • 38 patients (19%) of patients had a 0-day LOS on the DACE unit.
  • There was little difference between the percentage of patients who were stranded (7 day plus LoS) and super stranded (21 day plus LoS) who accessed the pathway as compared to all. There were zero patients who accessed the pathway that had a 100 plus day LoS, as compared to 8 patients for all admissions via DACE and PACE.
  • When comparing mean LoS, there was a difference of almost a day between the direct admission cohort of patients (8.6 days) and all admissions via DACE and PACE (9.4 days).
  • admissions via DACE and PACE.
  • When comparing the readmission within 7 days data, there was a difference of almost 2% between the direct admission cohort of patients (7.1%) and all admissions via DACE and PACE (8.9%).
  • All of the patients had their observations taken within 15 minutes of arrival and a clinician saw 75% within 1 hour of arrival. All the patients have had positive experiences of the pathway and have given verbal feedback to the DACE staff that the care that they have received overall has been of a very high standard. There have been no DATIX incidents recorded for these patients.

Some examples of the DACE patient / relative feedback are as follows:

– “Felt it was a much better experience and less stressful”

– “The whole process was so smooth”

– “He was so much calmer and settled more easily onto the ward”

– “The system of going straight onto the ward is fantastic and much quicker”

Staff feedback:

The DACE medical and nursing staff have been heavily engaged throughout the first PDSA cycle. They remain positive and are driven by the clear benefits for the patients. They have raised concerns regarding the times when they cannot support the pathway; these include the unavailability of an assessment bed.

Sustainability

1.     Does the Trust intend to continue with this response for the foreseeable future?

Yes – now business as usual and similar pathway just been implemented at another Mid Yorks site, Pinderfields Hospital.

2.     What long-term resourcing requirements are there?

None – existing clinical pathways team will continue to work with Mid Yorks.

3.     What risks have been identified (for patients / trust / system) in providing this service and how have these been mitigated?

No risks have been identified. Patients assessed quicker in the correct place. No reported incidents since the inception of the pathways. Acute Trust site has an A&E department should that be required, but there are no reports of this being utilised by patients that YAS have transferred directly to the frailty ward.

4.     Is there potential to expand this response model?

Yes, now expanding to other Mid Yorks site in Wakefield. The PACE unit (Pinderfields Acute Care of the Elderly) is larger and can accommodate local patients, reducing the time spent in ED waiting for assessment.

Sharing & Learning

1.     What has the trust learnt most from introducing this process?

Improvements in patient care and experience through direct access to frailty specialisms.

Investing focussed time engaging and communicating with frontline crews has improved knowledge of, and access to, this unit.

2.     What might be done differently with the benefit of hindsight if implementing again? (in another part of the Trust, for example)

Including patient flow coordinator at hospital being involved in early discussions

Consideration of same day discharges and how best to support this through the system.

ScHARR Evaluation

This Initiative has been the subject of an evaluation review by ScHarr – read the report here.

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