Charlotte Leonard, Caerphilly Community Resource Team
IGNITE Competition Shortlist
Information
I am a rapid response nurse working in the Caerphilly Community Resource Team (CRT) which is an integrated Health and Social Care Team. A priority aim of the CRT is preventing unnecessary acute hospital admissions. Whilst working in the team I was able to identify that a significant number of hospital admissions occurred in a particular group of people – those who were receiving care from the Emergency Home Care (EHC) service within the CRT.
Our aim to prevent hospital admissions and provide care closer to home is shared with Welsh government in key documents:
In order to explore this situation further an audit was performed to identify EHC clients who were admitted to hospital whilst receiving care from the EHC service. The data obtained identified that 41 EHC clients had an acute hospital admission between September 2019 to September 2020. Of these 41 admissions, 21 were initiated via the General Practitioner (GP) and 20 via the 999 Welsh Ambulance Service Trust (WAST). On examining the acute admissions and identifying the initial diagnosis it was identified that many of these admissions could have been prevented as the medical condition reported could be treated effectively in the home by the Rapid Response Service via CRT.
Domiciliary care is provided by Emergency Home Care (EHC) to people who live in their own homes but require additional support with activities of daily living including household tasks, personal care and any other activity that allows them to maintain both their independence and quality of life. EHC support is provided same day as a referral is made for 8 days.
The needs of clients who require EHC as part of the social care element of the CRT are complex and changeable, many with rapidly altering dependency level. Whilst ageing does not necessarily equate with increased morbidity and dependency it is often associated with increased needs for care and support and the subsequent development of “frailty”. These clients usually have difficulty accessing primary care services and attending GP practices and require home visits from health care professionals.
The EHC service provides care to clients with associated health needs who are usually elderly with a high degree of frailty and multiple co-morbidities. This particular group of people are very susceptible to sudden deterioration in their health status which often presents as just subtle changes in their general day to day presentation. If these changes in health status go unrecognised sudden and acute deterioration can follow resulting in an acute hospital admission.
CRT is a service provided by the Aneurin Bevan Health Board. The CRT provides help to adults, (over the age of 18) living in Aneurin Bevan locality who need support to stay independent, within their own homes.
The CRT offers an improved service that ensures individuals receive the right intervention, in the right place, at the right time, from the right professional. It simplifies the process by coordinating both health and social care needs.
Assessment
Review of initial Data, 41 emergency home care clients admitted to hospital September 2019 September 2020.
Analysis of the data identified 15% of admissions were unavoidable given the level of acuity. The remaining 85% acute hospital admissions were identified as a result of medical conditions that could be managed effectively in the home by the CRT Rapid Response Nursing/Medical service, preventing acute hospital admission.
Recommendation
1. RESTORE2 Escalation Package
RESTORE2 is a ph ysical deterioration and escalation tool for care staff. RESTORE2 makes National Early Warning Scores (NEWS ) accessible to care staff through the use of soft signs of deterioration. It includes a communication and escalation protocol developed with GP’s, ambulance providers and deterioration experts specifically for care staff to support them to raise concerns and a structured communication tool (SBARD) to ensure patients get the support they need.
The use of soft signs of deterioration can help with early detection of unwellness and provides the basis of a language to help communicate the intuitive feelings of EHC carers when “something just doesn’t feel right” and helping the emergency home carers to escalate their concerns earlier and enabling them to refer to the rapid response nurses for a full assessment to see if a hospital admission in avoidable. This will improve the patients experience by enabling the patient to stay at home and have access to rapid assessment and treatment. Preventing unnecessary hospital admissions, which will result in improved patient flow and increase WAST capacity and Secondary Care capacity.
2. New Referral Process
Creating a new service – Rapid Response nurses accepting referrals for patients who have been identified with the help of the RESTORE2 escalation package by Emergency Home Carers, this service development will enable rapid response nurses to perform a full nursing assessment and commence treatment quickly to prevent avoidable hospital admissions.
Currently if carers are concerned about a patient they ring the GP or 999, at the moment a lot of patients are getting admitted to hospital straight over the phone before they are actually seen by a GP. This idea would be a new service where these patient would be referred to the rapid response nurses for assessment and interventions to reduce avoidable hospital admission. I am working alongside Improvement Cymru on this project.
Conclusion
CRT’s priority aim is to prevent unnecessary acute hospital admissions, by introducing RESTORE2 and the new referral process, we will be able to recognise the unwell patient earlier therefore preventing subsequent onset of some complex medical conditions and hospital admissions.
Our proposed change is supported by data and we will continue to collect data to demonstrate the ongoing benefits to patients, staff and other services.
