early community support for frail elderly: putting evidence into practice dr ellie hothersall...

Early Community Support for Frail Elderly: putting evidence into practiceDr Ellie HothersallConsultant in Public Health MedicineNHS Taysidee.hothersall@nhs.net@e_hothersall

“All hands on deck”We need to find ways of ensuring a local focus on these issues. This should include access to good local data on public health issues, evidence of those interventions which are effective and access to expertise at the partnership level. This is a prime example of where significant local flexibility should go hand in hand with proactive efforts at a wider level to research and develop new approaches and promulgate them effectively.

http://www.alliance-scotland.org.uk/download/library/lib_51f8dfb426a3b

The evidence says…

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/older-people-and-emergency-bed-use-aug-2012.pdf

Patient centred care improves outcomes

Good or reasonable evidence of its potentially beneficial impactGood or some evidence for how to do it well

Community care is cheaper than hospital care

http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/older-people-and-emergency-bed-use-aug-2012.pdf

Prevention is better than cure…“… flexibility in service delivery is a necessary condition for providing for people's needs at home. … this flexibility has been found to be difficult to achieve in the public sector because of the nature of existing employment contracts and the high costs of paying for care outside normal contract hours.”

http://www.scotland.gov.uk/Resource/Doc/156782/0042157.pdf

Home visit request for elderly patientGP or other staff referral

Hospital discharge team referral

Daily “huddle”

Assessment/Comprehensiv

e geriatric assessment

ECS Coordinator

Medical Nursing

Physio OT Social work

3rd sector

Pharmacy

Practice NameNumber of ECS cases*

Practice population over 65

ECS cases per 100 eligible head of population

Grove Health Centre 112 1612 6.9

Carnoustie Medical Centre 71 2735 2.6

Broughty Ferry Heath Centre 68 2302 3.0

Monifieth Health Centre 65 2319 2.8

Total 316 8968 3.5

*This equates to the number of referrals, i.e. a patient seen once, discharged and then re-referred in the course of the project would be counted twice.

Increase in Anticipatory Care planning(Monifieth and Carnoustie Health Centres)

Data courtesy of Eric Blyth, Monifieth HC practise manager

Number of new ACPs Monifieth/ Carnoustie

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Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Emergency admission numbers from practisesinvolved in Winter project 2013-2014.

Admission numbers

Dec 2012-Feb10th 2013

Per 1000 practise population aged over 75

Dec 2013-Feb 9th 2013

Per 1000 practise population aged over 75

% reduction

Monifieth 91 83 63 58 30.8%

Carnoustie

85 75 72 63 15.3%

Broughty Ferry

88 72 73 60 17.0%

Grove 64 77 80 96 increase

Total 328 288 12.2%

Admission numbers (per 1000 practise population) aged over 75 years

58 63 60

96

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120

Monifieth Carnoustie B/Ferry Grove

Winter 2012-2013

Winter 2013-2014

Mean length of stay for population aged over75 years admitted from winter project practises. Winter project 2013-2014

Mean length of stay Dec 2012-Feb 10th 2013

Dec 2013-Feb 9th 2014

% reduction

Monifieth 7.5 6.2 17.3 %

Carnoustie 9.5 8.0 15.8%

Grove 18.1 11.8 34.8 %

Broughty Ferry 16.6 12.7 23.5%

Total 12.6 9.3 26.2%

Bed day impact of Enhanced support in the community. Winter project 2013-2014

Total bed days used

Dec 2012-Feb 10th2013

Per 1000 practise population aged over 75

Dec 2013-Feb 9th 2013

Per 1000 practise population aged over 75

% reduction

Monifieth HC 697 637 391 357 43.9%

Carnoustie HC 811 711 577 506 28.9%

Grove HC 1160 1398 781 941 32.7%

Broughty Ferry HC

1463 1199 930 762 36.4%

Total 4131 2679 35.1%

Beds per night 53.6 34.8 18.9 beds per night

(per 1000 practise population)

Reduction in Boarding from Ninewells Acute Geriatric Unit (Wards 5/6)

Number of Patients Boarding Outwith Wards 5/ 6December 2012-March 2013 compared to December 2013-March 2014

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ward 5/6 Dec 2012-March 2013

1253 bed days

Data courtesy of Angie Miller, quality and effectiveness lead for planned care

Everyone [on the nursing side] tries to go to all the meetings [MDTs], to get extra information and learning. All nurses feel their skills and knowledge have been improved. When team members discuss going back to traditional District Nursing roles, they feel they will carry this skill and knowledge with them

Social work: I think that one of the reasons why the pilot has worked well is the link between the social care team and the nurses, and I think we should be doing more in order to replicate this across other areas.

Acknowledgements

Dr Dougie LowdonDr Gail YoungLiz GossSandy BerryDr Alison ClementAll the ECS team and GP practices