Urgent Care Planning
in South Tyneside
David Hambleton
Urgent Care
Everyone’s problem
Urgent Care Plans
• Urgent Care –
– Everyone’s problem so nobody’s problem
• Why is it a problem
– High A&E attendances but
– Low admission rates
– Lots of people in A&E who needn’t be
Percentage of A&E Attendances
converting to Admissions
3
Over-crowding in A&E
Why it’s a very bad thing
• After admission through a crowded A&E
43% increased chance of dying at 10
days
• A&E stay of 4-8 hours increases
inpatient length of stay by 1.3 days
• A&E stay >12 hours increases inpatient
length of stay by 2.35 days
What can be done prior to
A&E
• GP Access
• Quality Premium (GP QOF)
– Ambulatory Care Conditions
– A&E usage
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•
•
•
Anticipating urgent care demand
Improved care in nursing homes
STICS - better management of LTC
RAID - rapid, effective and safe access to
mental health services
What can be done in
hospital
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•
•
•
Ambulatory Care Conditions pathway
GP in A&E?
White board system to track patients
Review spilt of beds between medical
and surgical specialties
• Rapid response clinics
• Psychological liaison service within an
Urgent Care hub
Discharge & out of
hospital care
• Hospital discharge process and
communication
• ‘Time to think’ beds
• Single point of contact for social care
• Reviewing current provision of self
management education and support
NHS 111 update
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•
•
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•
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National free-to-call memorable number
Single point of contact for urgent care
‘Talk before you walk’
NE system is working (unlike others)
Teething problem being ironed out
Opportunities still to be realised
NHS 111 update
• Patients directed to right services, first
time
• Directly booking appointments into
services – including GPs
• Better use of community services
• Indentify where gaps in service are
Teams involved
Programme for implement
DRAFT URGENT CARE SYSTEM MAP – South Tyneside Urgent Care Delivery Group
Self Care
Supporting
older
people at
home
• STICS (COPD)
• STICS (COPD)
• Nursing home
SLA/ LES
• Community
matron as care
coordinator
(evaluation)
Crisis
• ACS Pathway
review
• Single point of
contact social
care
Acute
setting
Step
down
• IRT
• Time To Think
beds
• Discharge
process
• Discharge
Communication
•Dementia Step
up facilities
•Perth Green
• PPP patients
• Telehealth/
wound sense
Supporting
older
people at
home
• STICS (COPD)
• Nursing Home
SLA/ Spec
Self Care
• Pulmonary
Rehab
• Cardiac rehab
•Pulmonary
Rehab
•Cardiac Rehab
• DNs/ flu
vaccines
• Zoning of
Urgent Care
nursing teams
*Primary care
*Primary Care
*Community
nurses (map
which teams)
Shared Care Plans
*A&E
*Local Authority
*Community
nurses
(map teams)
* Hospital staff
* SW team
* LA
* FT
*Primary Care
*Community
Nurses (map
which teams)
*Rehab teams
Tools Risk stratification - (in use in a fragmented way, i.e. separately in FT and Primary Care); not yet in use in LA
= opportunity to streamline, agree consistent cohort? e.g. at risk of admission
Standard Care Plan – opportunity
Standard work – across the pathway for this group involving teams and shared understanding, + time based
standards = opportunity (see Nottinghamshire work in progress on frail elderly pathway care standards)
Round Table Discussion
• On your tables you will be asked to
consider:
• Are we on the right lines with our plans?
• What else should we be thinking about
doing?