Care home resident’s emergency admissions to hospital of cut by 45%

NHS Calderdale Clinical Commissioning Group (CCG) has pioneered a clinically-led approach to improving the health of care home residents which has, so far, cut emergency admissions of care home residents 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 residents in Calderdale, Yorkshire. The ‘Quest for Quality in Care Homes’ initiative involved 1,300 care home residents 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:

1. cut emergency admissions of care home residents by 33%;

2. made savings equating to approximately 7,000 hospital bed days;

3. reduced GP care home visits by 45%.

How does the Quest MDT work with GPs to reduce the amount of care home visits?

1. “The MDT supports the work of GPs in care homes but mainly offering clinical support to ensure the needs of residents are met – for example, advising on ways to prevent falls and incidents that could affect residents’ health,” Dr Cleasby, clinical chair of NHS Calderdale Clinical Commissioning Group explains:

2. 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 residents to access planned and unplanned care services and ensure that patients are proactively managed to keep them within the care home setting,” Dr Cleasby says; the focus is on preventative care that is sustainable and connected.

3. The team also works with secondary care staff to support the early discharge, where appropriate, of care home residents who have attended A&E and/or been admitted to hospital.

The role of telecare

1. To date, more than 1,300 residents 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 residents leave their beds during the night, for example.

2. “In Calderdale we have found that using telecare in care homes gives users continuous, discreet support and enables carers to respond quickly to any incidents or alerts, which can prevent incidents”.

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 The Quest for Quality initiative aims to:

1. Reduce avoidable ambulance call outs, A&E attendance, hospital admissions and GP visits

2. Improve resident/patient care and safety

3. Respond more effectively to urinary tract infections, respiratory infections, falls and fractures

4. Support staff to feel confident in providing high quality care

5. Improve quality of life for residents More than 1,300 residents 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. Comparing 2016/17 to 2017/18:

6. Emergency admissions relating to falls have decreased by 7.7% resulting in an annual saving to the Quest programme of more than £200,000.

7. 50% of care homes saw a reduction in falls of at least 10%.

8. Fall-related incidents as a percentage of total incidents decreased from 25.7% to 23.7% year-on-year

Summary Calderdale is one of the care home initiatives demonstrating what impact clinically-led technology-enabled models could have on a national scale. The outcomes achieved are impressive in terms of a reduction in emergency admissions and cost savings. But are we in danger of losing service user choice and preference, mantras of the CQC and the rights of service user choice. As patients are proactively managed to keep them within the care home setting. Should we be sacrificing their independence and choice in order to receive a medical service appropriate to their needs? Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy