The Urgent Care team from South Sefton CCG introduce themselves and present how they've introduced QI through a Local Point of Contact and PDSA cycles.

1. Urgent Care Team South Sefton

2. Urgent Care
Who are we?
The team consists of Advanced Nurse practitioners, Allied
health professionals and Health Practitioner Assistants.
The team are skilled in clinical examination, clinical
diagnostics & are non medical prescribers. They have a
variety of experience in different fields that makes a well
rounded team of acute & community experience
Based at Litherland Town Hall, we provide rapid response
(within 2 hours) Urgent Care for the residents of South
Sefton under the clinical lead of Community Consultant
Geriatrician Dr Asan Akpan

3. GP / GP OOH/ Community
Local point of contact
EMIS Web
Community
GeriatricianUrgent Care Team
Generalist
& Specialist
Nurses
Care
assistantsTherapists
Weekly
‘Hot’
clinic
• 365 days
• Active 0800-2100
• < 2 hour response
• 72 hour care
• Integrated with I-care
SOUTH SEFTON URGENT CARE TEAM
For sub-acute patients who otherwise would be at risk of requiring acute trust admission

4. Quality Improvement and
Urgent Care
South Sefton CCG, Dr Akpan & the urgent care team started working
together in 2014. They recognised that to manage patients with
chronic disease, frail, unwell or needing social support or
rehabilitation needed a different approach, an integrated MDT
approach
Starting point: introduced to QI and how it could support
organisational change. Our Aim, how could we deliver services in the
community avoiding unnecessary admissions
Our first initial change was to support a simple referral process, with
the support of PDSA cycles we developed a Local Point of contact
for referral

5. Example PDSA:
PLAN Create a local point of contact for Gp’s and health professionals in
South Sefton to refer patients to the urgent care team as an
alternative to hospital admission
DO • Introduced a direct referral line to the urgent care team, which
enabled trained call handlers to accept referral’s for the team
• Chose one locality to pilot the referral line in (Bootle) and took
Gp referral only for this time
STUDY We looked at feedback from Gp’s, number of referrals, time the
team was active & response time, and the affect on workforce &
capacity with new referral system,
ACT The referral line was successful, with little negative impact on the
team, and positive impact on GP & patient care. This was
implemented and is currently supporting numerous clinical
pathways for the Urgent care team

6. Example PDSA ‘ramp’:
Transfer of MEWS to community
PDSA 2: New form simulation & feedback from
nurses > version 02
S D
A P
S D
A P
S D
A P
S D
A P
S D
A P
PDSA 3: Use-ability
n=19 patients > version 03
PDSA 1 : Mews calibration from Acute Trust (n=100
UCT patients) > version 01
PDSA 5: Repeat (4) following changes
across variety cases n=80 > Version 05
PDSA 4: COPD, obs threshsolds,
response
to MEWs n=51 patients
> version 04
Adapted MEWS
assessment
incorporated &
Implemented

8. How we overcome challenges
 We have a “team huddle” every morning where we discuss
the challenges from the previous day and how we can
overcome them
 Strong Clinical Leadership (from Dr Asan Akpan )
 Promote Team Work / Good Communication
 No blame culture & we learn through the QI tools we use
 “Can Do” attitude
 The patient comes first every time
 Flexible working
 Dedicated staff
 Share good practices and successful outcomes

9. How do we know our changes
make a difference?
Patient Story
• Mrs A, 85 year old, lives with her daughter who is her carer. Mrs A has diabetes
and has become unwell with a urine infection. Mrs A is normally independent,
but with the infection has become lethargic, wobbly on her legs and unable to
self care whilst her daughter is in work.
• Mrs A gets frequent urine infections, her diabetes is poorly controlled and she
has had 5 admissions so far in the last 6 months
• Previous to the urgent care team Mrs A would have been admitted again,
however her Gp referred her to the urgent care team
• The urgent care team responded within 2 hours, completed a full holistic
assessment, examination & in collaboration with the GP developed a care
treatment plan for the next 72 hours
• Mrs A remained at home, with her daughter, and continues to be a patient of
the urgent care team in times of ill health or crisis.

10. Measuring impact: Run charts

11. What are we planning next?
• A&E community link nurses to facilitate transfer out
A&E to community
• Expanding nurse role to include other treatments
such e.g. IV abx,
• Point of care diagnostics
• Working more closely with NWAS, out of hours GP

12. Questions
.