Croydon Health Services Acute Care Pathway Reconfiguration A Whole System Multi-Disciplinary Approach in an Integrated Acute and Community Trust Croydon Health Services NHS Trust Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013 More information about this event can be found at http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx

1. Croydon Health Services Acute Care Pathway Reconfiguration
A Whole System Multi-Disciplinary Approach in an Integrated Acute and Community Trust
Croydon Health Services NHS Trust is an integrated acute and community healthcare provider serving a population of around
360,000 in south London. There are approximately 145,000 Emergency Department attendances per annum, and since April
2012 the Emergency Department has worked alongside an Urgent Care Centre at Croydon University Hospital.
In recent years the Trust has struggled to maintain ED performance against the 4 hour standard, with a lack of consistency in
clinical care and patient flows for non-elective admissions. There has been a substantial investment in a new Acute Medical Unit
and with 8 acute physicians, and this has been a key enabler in our approach to Acute Care Pathway reconfiguration.
Quality, Innovation,
Productivity and Prevention
The 2013-2014 QIPP Program has used Croydon Health
Services’ structure as an integrated acute hospital and
community services trust to develop a program
coordinated through a whole system approach to Acute
Care Pathway reconfiguration.
The main QIPP projects have been aligned to these key
themes:
1.
2.
3.
4.
5.
6.
Ambulatory Care and Admission Avoidance
Integrated Long Term Condition Care
Safe Early Discharge
Acute Care of the Elderly
Transforming Adult Community Services
Seven Day Working
These themes share the objectives of providing safe,
effective, high-quality integrated care, closer to patients’
homes, with consequent reductions in inpatient bed
requirements and improved Emergency Department
performance against the 4 hour standard.
Projects and Actions
Stakeholder Engagement
Key Outcomes
1. Ambulatory Care Pathways & Admission
Avoidance
The Croydon Urgent and Emergency Care Board meets
regularly and includes senior leaders from Croydon Health
Services, Croydon CCG, Croydon Urgent Care Centre
(Virgin-Wandle Assura), London Ambulance Service,
Croydon Council Social Care, pharmacies, voluntary sector,
and other local commissioning and provider organisations.
There is regular engagement with patient representatives
and action on carer feedback, as well as learning taken
from clinical incidents and events.
The progress of each scheme has been monitored against
a series of implementation milestones. There have been
measurable improvements as a direct result of specific
schemes. For example the Integrated Heart Failure Service
has led to a reduction in heart failure admissions, and a
readmission rate of 8%, compared to a national average
of 18%. Seven day working with more frequent and timely
senior medical review has increased the number of
weekend discharges, and led to improved feedback from
patients.
Clinically Led Transformation
The key outcome measures of whole system benefits of
this transformation program have been significantly
improved compared to 2012:
Ambulatory Care for DVT, low risk PE, low risk
pneumonia, cellulitis, and first seizure.
Increased use of existing rapid access clinics for stable
angina, COPD and TIA.
2. Integrated Long Term Condition Care
Integrated Heart Failure Specialist Nurse Service to
deliver evidence-based therapy and to manage
chronic community care and acute exacerbations.
CRT – Croydon Respiratory Team – integrated nursing
care and COPD Hot Clinic.
Inflammatory Bowel Disease Specialist Nurse for
chronic and exacerbation care.
3. Safe Early Discharge
Improved discharge planning and performance
Patient navigation for early discharge with outpatient
investigation
Reducing delayed transfers of care
4. Acute Care of the Elderly
The QIPP has required consistent and enthusiastic
leadership form medical staff, nurses, allied healthcare
professionals and professional managers across the Trust
in acute and community settings. A weekly QIPP Steering
Group meeting including senior clinical leaders and
executives has monitored progress and directed the
program.
The Clinical Directors for Hospital Based Pathways and
Integrated Care have been responsible and accountable
for project initiation, completion of milestones,
operational performance, finance and benefits realisation,
supported in a triumvirate by an ADO and ADN
95.3%
year to date performance against the 4 hour ED standard
60
fewer inpatient beds in use in September 2013 vs. 2012
90%
bed occupancy compared to 100% September 2013 vs. 2012
Consultant Elderly Care assessment of ED and AMU
referrals for admission avoidance
Future Developments
Early MDT approach to complex frail elderly for
coordinated early discharge
The themes of the 2013-2014 QIPP program will be carried
forward into 2014-2015, and it is anticipated that progress in
the current schemes will realize further benefits. In particular
the Transforming Adult Community Services program will
radically change the pace and scale of the community based
response to complex, frail elderly patients who are often
admitted to hospital when the underlying issues may be more
related to social and care needs than medical deterioration.
5. Transforming Adult Community Services
Single point of access for community services
Rapid response by a multi-disciplinary team for
admission avoidance
6. Seven Day Working
12 hours a day, 7 day a week consultant physician on
site at CUH
7 day Acute Medical Unit MDT meeting with
enhanced Occupational and Physiotherapy
7 day CCU consultant cardiologist rounds
7 day consultant surgeon and orthopaedic surgeon
rounds
A number of new projects will be developed, for example
integrated atrial fibrillation care and acute surgical care. The
wider transformation program will also address the challenge
of cultural change for medical and nursing staff in considering
which patients really require inpatient care and those can
safely be managed in an ambulatory or community setting.