GP’s are always on the lookout for innovative initiatives that will lead to are improving care while driving efficiencies. NHS Calderdale Clinical Commissioning Group (CCG) has pioneered a clinically-led approach to improving the health of care home service users which has, so far, cut emergency admissions of care home service users by 33% and reduced GP care home visits by 45%.
NHS Calderdale Clinical CCG – in partnership with Calderdale Council and Calderdale and Huddersfield NHS Foundation Trust – has pioneered a telecare-supported programme to improve the health of care home service users in Calderdale, Yorkshire. The ‘Quest for Quality in Care Homes’ initiative involved 1,300 care home service users over five years, with a multi-disciplinary team (MDT) – the Quest team – and care home staff working to improve care and prevent avoidable emergency attendances and admissions.
Since 2013 the care home teams involved have used Tunstall Healthcare technology to support individual care plans for residents, enabling the prevention of incidents. In the launch phase – 2014 to 2016 – following the introduction of the Quest multi-disciplinary team, NHS Calderdale CCG has:
- cut emergency admissions of care home service users by 33%;
- made savings equating to approximately 7,000 hospital bed days;
- reduced GP care home visits by 45%.
The Quest team players
So, how does the Quest MDT work with GPs to reduce the amount of care home visits? “The MDT supports the work of GPs in care homes but mainly offers clinical support to ensure the needs of service users are met – for example, advising on ways to prevent falls and incidents that could affect service users.
The MDT is made up of dedicated Quest matrons, a Quest nurse, a Quest healthcare assistant, consultant geriatrician, pharmacist and mental health practitioner, and has links to other areas such as the district nursing and community matron teams and palliative care. The MDT works with the key stakeholders including care homes, Calderdale Council and primary and community care staff to minimise the need for service users to access planned and unplanned care services and ensure that patients are proactively managed to keep them within the care home setting.
The team also works with secondary care staff to support the early discharge, where appropriate, of care home service users who have attended A&E and/or been admitted to hospital.
The role of telecare
To date, more than 1,300 service users have been supported through the Quest for Quality programme using technology, including bed occupancy sensors, fall detectors and movement detectors; the technology is in operation 24/7 and alerts staff when service users leave their beds during the night, for example.
Reducing GP care home visits by 45%
While GPs don’t directly work with the technology on the project, they work with the Quest MDT and the care homes and, ultimately, benefit from the project and technology. The Quest programme has meant GP call outs to care homes have been significantly reduced – by an impressive 45%; this is because the Quest MDT works directly with the care homes and, given the additional support and quick response to incidents and incident prevention, they call for a GP less often.
Gauging the impact on workload, quality of care and cost savings
A key focus of the pilot project was to reduce hospital admissions from care homes, increasing quality of life for service users and reducing demand on primary and secondary care.
This led to the development of the Quest for Quality in Care Homes pilot, which combined a MDT, real-time access to live clinical records for GPs and Quest for Quality in Care Homes matrons, and telecare and telehealth systems to improve the quality of care and help to reduce avoidable hospital and GP visits. It aimed to:
- Reduce avoidable ambulance call outs, A&E attendance, hospital admissions and GP visits;
- Improve resident/patient care and safety;
- Respond more effectively to urinary tract infections, respiratory infections, falls and fractures;
- Support staff to feel confident in providing high quality care;
- Improve quality of life for residents.
More than 1,300 service users have been supported in 38 homes as part of the Quest for Quality over the last five years, and the project has achieved significant financial efficiencies and associated cost savings since it was introduced.
- Emergency admissions relating to falls have decreased by 7.7% resulting in an annual saving to the Quest programme of more than £200,000.
- 50% of care homes saw a reduction in falls of at least 10%.
- Fall-related incidents as a percentage of total incidents decreased from 25.7% to 23.7% year-on-year
Results from the pilot project carried out NHS Calderdale Clinical Commissioning Group show some impressive results. Reducing visits to care homes by GPs by up to 45%. While this is no doubt welcome news to GP’s who are grappling with the problems of scarce resources, I trust that this is not at the cost of regular reviews of the overall health needs of service users. The reduction in falls and falls related incidents can be attributed to the use of technology, and costs permitting we will see a greater use of such technology for the benefit of service users in the future.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy