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JuneUrgent Care in Derby                                        2010Rakesh MR k h Marwaha  hDirector of Performance and Kn...
Contents About Derby  About Derby The Problem Evidence Gathering Actions / Outputs  Actions / Outputs Summary
About NHS Derby City Integrated organisation since 2004 Population served c291,000 (census c243,000) Resource allocatio...
About NHS Derby City
Contents About Derby  About Derby The Problem Evidence Gathering Actions / Outputs  Actions / Outputs Summary
The Size of the Problem                      Non Elective Admissions and A&E Attendance                                   ...
The Size of the Problem ‐ Comparator                                                                PCT in East Midlands p...
Contents About Derby  About Derby The Problem Evidence Gathering Actions / Outputs  Actions / Outputs Summary
Examining Urgent Care                        Where                        When                        Who                 ...
Examining Urgent Care – GP Audit                                                                                 One area...
Examining Urgent Care ‐ MCAPResource Utilisation (Bed Census) AuditA panel of nurse reviewers used the Oak Group Criteria...
Examining Urgent Care ‐ MCAPResource Utilisation (Bed Census) AuditA panel of nurse reviewers used the Oak Group Criteria...
Contents About Derby  About Derby The Problem Evidence Gathering Actions / Outputs  Actions / Outputs Summary
Current Status  Service   S i          Rightcare – over 400 patients registered ££saved                Rightcare  over 40...
Contents About Derby  About Derby The Problem Evidence Gathering Actions / Outputs  Actions / Outputs Summary
Tier 1 Service                                                                                                            ...
Summary Problem     14% growth in admissions     5% increase in activity with 19% rise in cost (Tariff cost, HRG4 and L...
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Rakesh Marwaha & Ian Hays: Urgent care in Derby

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Transcript of "Rakesh Marwaha & Ian Hays: Urgent care in Derby"

  1. 1. JuneUrgent Care in Derby 2010Rakesh MR k h Marwaha hDirector of Performance and Knowledge ManagementIan HaysSenior Knowledge Officer g
  2. 2. Contents About Derby About Derby The Problem Evidence Gathering Actions / Outputs Actions / Outputs Summary
  3. 3. About NHS Derby City Integrated organisation since 2004 Population served c291,000 (census c243,000) Resource allocation c £447m Resource allocation c £447m  HCC results Good for quality, Good for use of resources 69th most deprived local authority out of 354 Significant internal variance: Derby contains Lower Level  Super Output Areas listed in both the most deprived 20%  S O t tA li t d i b th th t d i d 20% and the most affluent 20% in England 
  4. 4. About NHS Derby City
  5. 5. Contents About Derby About Derby The Problem Evidence Gathering Actions / Outputs Actions / Outputs Summary
  6. 6. The Size of the Problem Non Elective Admissions and A&E Attendance Cost per Non Elective Admission Trends ndances Emerge 82000 36000 2009/10 - ency AdmissionsA&E Atten 80000 35000 £1730 78000 34000 76000 33000 s 74000 32000 72000 2008/09 - 31000 70000 £1510 30000 68000 Total Cost 29000 2007/08 - 66000 Annual A&E Figures Annual NEL Adms £1500 64000 28000 2005/06 2006/07 2007/08 2008/09 2009/10 Total Activity  12.5% growth in A&E Attendances in last five years  Significant increase in cost per patient for non   14% growth in emergency admissions in last five years 14% growth in emergency admissions in last five years elective admissions due to tariff price change, HRG  elective admissions due to tariff price change HRG 4 and Length of Stay costs
  7. 7. The Size of the Problem ‐ Comparator PCT in East Midlands peer group PCT i E t Midl d PCT 1 116 PCT 2 123 PCT 3 124 Non‐ elective  PCT 4 128 PCT 5 PCT 5 128 admissions are high  d i i hi h PCT 6 129 compared to peers  PCT 7 148 Derby City 174 and benchmarks PCT 9 213 +22% Ø 143 PCT in ONS peer group PCT 1 138 Non‐elective admissions per 1,000 weighted  PCT 2 138 population, 2008/09 PCT 3      149 PCT 4 151 PCT 5      152 Derby 174 PCT 6      154 PCT 7         PCT 7 161 PVT 8 162 East Midlands 136 PCT 9 163 PCT 10 174 Derby City 174 ONS 154 +12% Ø 156 7SOURCE: Dr Fosters data 2008/09; 2007 weighted pops ONS, Business Intelligence Unit
  8. 8. Contents About Derby About Derby The Problem Evidence Gathering Actions / Outputs Actions / Outputs Summary
  9. 9. Examining Urgent Care Where When Who How Why ?
  10. 10. Examining Urgent Care – GP Audit  One area identified of  particular concern was the  particular concern was the rise in conversion rate from  A&E attendances to  emergency admissions emergency admissions  GP Audit was carried out  to check validity of GP direct  admissions Findings: The GP Audit of Emergency Admissions carried out in March 2009 found that of 378 recorded admissions, 70 (19%) were assessed as avoidable.*that of 378 recorded admissions 70 (19%) were assessed as avoidable **Performance and Knowledge Management Directorate (2009) GP Audit of Emergency Admissions Derby Hospitals Foundation Trust 
  11. 11. Examining Urgent Care ‐ MCAPResource Utilisation (Bed Census) AuditA panel of nurse reviewers used the Oak Group Criteria to review :i. all non‐elective patients admitted between 16‐22 August  2009 ii.ii all patients in a care bed with an in‐hospital length of stay of five days or more. all patients in a care bed ith an in hospital length of sta of fi e da s or more
  12. 12. Examining Urgent Care ‐ MCAPResource Utilisation (Bed Census) AuditA panel of nurse reviewers used the Oak Group Criteria to review :i. all non‐elective patients admitted between 16‐22 August  2009 ii.ii all patients in a care bed with an in‐hospital length of stay of five days or more. all patients in a care bed ith an in hospital length of sta of fi e da s or more25% (16) were assessed 25% (16) were assessed 34% of patients with a stay of five  34% of patients with a stay of fiveas not qualifying for an  days or more were assessed as acute admission not qualifying for such a stay29% of all non‐elective bed days in  Between 44% ‐ 63% of Derby are within Medicine for the Derby are within Medicine for the acute bed days are  acute bed days areElderly inappropriate  (UK studies)
  13. 13. Contents About Derby About Derby The Problem Evidence Gathering Actions / Outputs Actions / Outputs Summary
  14. 14. Current Status Service  S i  Rightcare – over 400 patients registered ££saved Rightcare  over 400 patients registered, ££saved  100% of Practices extended hours Avoidance  Social Marketing – Outreach team Admission   Service Navigation ‐ 4 diverts/day, ££  IV Therapy, DVT & Catheter ‐ ££cash released h h h l d Avoidance   MAU Triage – New clinical model implemented  Transitional Beds = 510 Emergency & 3129 rehab bed   Community  days saved  Early supported discharge – ££saved  y pp g Service  Continuing Care costs falling in opposition to other East  Mids PCTs
  15. 15. Contents About Derby About Derby The Problem Evidence Gathering Actions / Outputs Actions / Outputs Summary
  16. 16. Tier 1 Service Tier 2 ServiceSummary Tier 3 Service Tier 4 Service Referral Management   / Follow Up Primary  Care 10 Point Plan  10 Point Plan Primary Care  Foundation ACUTE  Service Navigation Team – RightCare EXPANDED AND  HOSPITAL earlier discharge (MCAP audit  A&E, Mental Health, Social,  ENHANCED  Intermediate & Continuing  Care, Voluntary Sector) Long Term Conditions L T C di i HOME COMMUNITY  Staying  Referral admissions  standardisation SERVICES New model for ACS conditions – earlier discharge Healthy Enhanced Step Up/Down & Comm  Service Navigation  Intermediate Care Services  (phase 2) EMAS  DHFT Review MAU(CDU) DEMAND p   Duty Doctor MANAGEMENT Improved resource Utilisation Walk In Centre ReviewSELF CARE Social Marketing  Discharge PlanningExpert Patient Programme Campaign Rapid 1 hr Community Response team New Patient flow teamHealth CoachingRightCare Falls, Stroke,  Falls Stroke Care of the Elderly  Care of the ElderlyWelcome Pack for New  Respiratory pathway Trauma, Alcohol Physician in A&E/MAUEntrants Evening suspected DVT service Contracting Catheter service pathway IV therapies service Transitional / Intermediate Care INTEGRATED CARE MODEL
  17. 17. Summary Problem  14% growth in admissions  5% increase in activity with 19% rise in cost (Tariff cost, HRG4 and LOS) E id Evidence  Systematic and triangulated evidence gathering from external audits  Benchmarking g Actions  Defining Knowledge reports to Board  Plans, implement, robustly performance manage, continuously improve  Robust transformation and contract management with providers Outputs Outputs  ££savings delivered to date with On Target Savings of ££savings
  18. 18. QUESTIONS
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