Safely Reducing Avoidable Conveyance Programme

Frailty Response Line, Hull & East Riding

Brief Description of Initiative

Reactive service introduced by the community services provider in Hull, City Health Care Partnership (CHCP), who provide pro-active frailty service at their Integrated Care Centre (Jean Bishop Centre), reducing unnecessary admissions to hospital by providing care out of hospital.

During the Covid-19 pandemic the service set up a Frailty Response Line, accessible by ambulance clinicians, primary and community care staff, with the aim of providing care in the right place for the frail population who were suffering with Covid-19. The service also agreed to provide advice to patients who were not suspected to be suffering from Covid-19.

The response line is supported by a consultant Geriatrician and advanced practitioners with the potential outcomes being: Home management, end of life or advance care planning, the provision of Just In Case Medicines, step up community beds, provision of antibiotics, home visits.

Date Initiative was introduced in Trust

28th March 2020.

Date of upload or review

Uploaded to Repository 24th July 2020.

Introduced as part of COVID-19 response?

Yes.

Background Context

A service introduced to support care in the community for frail patients suffering from suspected or confirmed Covid-19. See description above.

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

Care Homes and patients in their own homes with a clinical frailty score of ≥ 5.

Geographical area or location covered by this response model

Hull and East Riding of Yorkshire (the two CCG areas).

Key Aims
  • Reduce avoidable admissions to ED for patients suffering with and without suspected Covid-19 who are frail and / or in a care home
  • Provide the right treatment, in the right place – based on patient choice
  • Aid clinical decision making to ensure the right care.
Benefits for Patients
  • Provision of care in the right place
  • Provision of care at the right time, reducing the need to attend hospital and ED where possible
  • Direct access to specialist geriatrician support and the development of patient centred care and treatment plans.
Benefits for Trust or System
  • Reduction in avoidable attendances at ED and admissions to acute Trust
  • Provision of care closer to home, discussion with YAS clinicians and patient
  • Development of care and treatment plans, potentially reducing the demand on the 999 system through collaboration
  • Supporting ambulance clinicians to make difficult clinical decisions.
Implementation

1.     How long has this initiative been operational?

Since end March 2020

2.     Days / Hours of operation:

Was 7 days per week, 08.00 to 20.00.

Now reduced to Monday – Friday, 08.00 to 18.00 as normal service resumes.

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

Clinical Pathways Team for YAS involved in the development of the pathway for YAS access into the service.

Community Geriatrician, Advanced practitioner’s and GPwER.

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

Hull CCG.

Hull City Health Care Partnership.

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

None.

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

CCG funded.

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

Collaborative working across organisational boundaries.

Good communications with frontline staff.

Positive interactions between provider and frontline ambulance clinicians when referring.

Use of video consultation with involvement of clinician, patient and family / carers.
Patient-centred care.

Evaluation & Monitoring

1.     What are the key success measures?

  • Number of referrals made by YAS crews
  • Development of a care plan, enabling care closer to home where possible
  • Reduction in conveyance to ED from care homes.

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

Monitored and measured by provider.

Able to extract some high level data from YAS power BI dashboards regarding conveyance rates and care home attendances / admissions.

3.     Has a formal evaluation process been undertaken (independent / inhouse)?

Evaluation undertaken by provider, CHCP, as part of the whole project. Discussed and shared with YAS.

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

175 patients referred to service between 23rd March and 31st May 2020 of which 35 had suspected or confirmed Covid, and 140 non-Covid.

Of the 35 Covid patients: 29 remained at home.

Of the 140 non-Covid patients: 82 remained at home.
Majority of patients age 75-94.

Sustainability

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

Yes as long as the service is provided. The hours have been reduced recently due to the return of the pro-active work the service offers returning.

2.     What long-term resourcing requirements are there?

None from a YAS perspective.

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

Normal risk associated with non-conveyance of patients by ambulance crews apply but these are well mitigated by joint care planning, use of video technology, joint decision making with patient and family and where required a rapid 2 hours response or step up bed.

4.     Is there potential to expand this response model?

Yes, to other areas of Yorkshire, and could be used as an exemplar model across UK

Sharing & Learning

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

Rapid scale of implantation is possible.

Collaboration and positive experience by the ambulance crews has a very positive impact on increasing referrals and utilisation of the service, through word of mouth feedback amongst crews.

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

The same process would be followed.

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