7ds taunton bristol council & ccg bevleigh evans
TRANSCRIPT
Access to 7-day ServicesMeeting the local challenge: one size
does not fit all
4th March 2015
Better Care Bristol
What did Bristol do?
• Fact finding audit on what services needed to be available to reduce emergency admissions
• Saturday morning ‘front door audit’ to assess what was needed (attached)
What happened next…
Acute – Access to 7 Day Service • More frequent use of criteria led discharge at
weekends • Work with partners to extend the Liaison
Psychiatry coverage• Work with partners to extend support to complex
discharges• Further development of Diagnostics services at
weekends• Care Home Selection• Integrated Discharge Hub
Community – Access to 7 Day Service
• Community discharge facilitation and admission avoidance are 7-days with scaled down hours –ongoing review of what is needed and the impact
• REACT – Rapid Emergency Assessment Care Team (based in ED & OPAU)
• Community Discharge Coordination Centre –Discharge to assess, reablement, rehabilitation pathway
Mental Health – Ahead of the game?
• 24/7 offering a single point of access, crisis line, response to ED and community/ home visits.
• April 2015 extending assessment and recovery service to provide 8-8 7-day/ week coverage.
Primary Care - Access to 7 Day Services
• BrisDoc Professional Line 24/7
• GP Support Unit at the front door is 7 days
• Weekend GP review
You don’t always get what you want
• What is required? • Piloting social care working weekends in NBT during winter on a
short term basis. Positive effect in terms of keeping on top of S2s, progressing some weekend discharges and avoiding a Monday catch up syndrome.
• Could there be a greater focus on admission avoidance at weekends?
• Keen to move to permanent 7 day working but need to work with HR to change working arrangements and contracts
• Need the system wide approach – consideration of other services, e.g. Brokerage, providers being contactable and able to start packages, non-hospital community bed availability
499480
427
357236
200188169199
5306
836
851
648
698
701
549570
Emergency Admissions 65 + UHB bytimeband
00 to 01
01 to 02
02 to 03
03 to 04
04 to 05
05 to 06
06 to 07
07 to 08
08 to 09
Inhours
17 to 18
18 to 19
19 to 20
20 to 21
21 to 22
22 to 23
23 to 0029.9% between 17:00 and 22:00
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Saturday Sunday Monday Tuesday Wednesday Thursday Friday
OOH Emergency Admissions per day 65+
Ref no Scheme
1 Deteriorating Patient - Early & Preventative Interventions
2 Admissions Avoidance – Community
3 Admissions Avoidance - Front Door
4 Integrated Rehabilitation & Reablement
5 Frail and Complex, Falls Prevention, including Community Geriatricians and Long Term Conditions
6 Joint Commission Information and Advice Services
7 Long term care options for people with mental illness and learning disabilities (section 117 after care)
8 Extra Care Housing
9 Carers Breaks
7
7
Solutions
• Needs to be system wide• Need to consider smoothing out over 7 days• More generalists to cross-cover• Single point of access• Care coordinator that can help patients through
the system• Wider use and acceptance of technology