developing the ahp neuro navigator in nwl – lessons from barnet nadia jeffries:...
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Developing the AHP Neuro Navigator in NWL – Lessons from Barnet Nadia Jeffries: Neuro-rehabilitation pathway co-ordinator for Barnet and Enfield and Jess Henderson ICHP6 July 2015
The QIPP Challenge:
• There are 197 Level 1/2a Specialist Neurorehab beds across
London.
• There is a mismatch between demand and capacity for Level 1/2a.
• There is a shortage of Level 2 beds (77 across NWL, NCL and SWL)
• Long acute waits (median* 52 days from referral to admission) with
an average 95 number of patients waiting at any time.
• 2014/15: at any one time 13 patients recorded as Delayed Transfer
of Care to leave Level 1 units (NHSE 2015)
• 2014/15 approx. 5,400 bed days were lost in Level 1/2a units due to
Delayed Transfer of Care equivalent to £1.6 million cost to London
CCGs (NHSE 2015).
INNOVATION: Here is what the patients of North West London told us
4
We don’t think information is
exchanged across the
system about our care and
needs
As patients and families, we don’t feel we are kept up to
date on what is happening with
our care
We don’t think we get access
to all the services
available to us, because teams
don’t know what is
available in the system
We waited a long time to get access to
specialist neuro-
rehabilitation
We felt discharge
planning was not fully
considered
We think community and
voluntary services are available but we struggle to access them
Each injury is different, we need tailored
support packages to
help us recover
We need to get life back on track, this
means help with getting
into work and access to benefits
This event has impacted our families and
changed their lives, they need
help too
QUALITY: We see the neuro-navigators as key roles for alleviating some of the issues in the system
Advocate for patients and families and act as a ‘communication beacon’ between them and clinical teams
Understands the system complexities and how to leverage the services available locally
They will be a critical role within the MDT, proactively advising on how best the system can accommodate the patient needs promptly
Manages transitions between acute, specialist rehab and community discharge and accessing appropriate support services
Minimises delays and optimises rehabilitation outcomes by navigating the most appropriate individual patient pathway
5
The Barnet Experience: Innovation through the
Development of a District Level service
Case Management
Community Neurological Conditions Management
Team (including Vocational Rehabilitation)
In-patient condition
managementIn-patient
rehabilitation
Person Centred
Information Resource
Single point of access
Life long access
Productivity: Discharge from acute ward
• Economic impact analysis is challenging due to multi-factorial
influences on patient pathway.
• 2013/14 Barnet Neuro-navigator supported 29 patients. 19 patients
were transferred to Level 1 units (median waiting time 63 days (Min
6 to Max 117 days) and 8 patients re-directed to Level 2 unit
(Median waiting time 14 days).
• This equated to an average saving of 49 acute bed days per
patient and a total of 392 acute bed days equivalent to £81,312.
Productivity: Discharge from Level 1 to Community
• DTOCs from Level 1
units associated with
£1.6 million cost across
London CCGs (NHSE,
2015 ) *
• Possible correlation with
support from Neuro-
navigators -complex
analysis.
• Cost of 8a Neuro-
navigator: £60,500*
SE London
SW London
NE London
NW London
NC London
0
500
1000
1500
2000
2014/15 DTOCs (Bed Days) By CCG (NHS England 2015)
2014/15 DTOCs (Bed Days) By CCG (NHS England 2015)
SE London
SW London
NE London
NW London
NC London
00.5
11.5
22.5
33.5
Neuronavigators
Neuronavigators
* Ref : NHS Purchased Healthcare, 2015 Specialist centre delayed discharge improvement project output
Prevention and Sustainability
• Prevention of rehabilitation and health related secondary complications
associated with extended acute stays (often in non specialist
environments).
• New NN posts in NW London , Enfield CCG, Ealing CCG and SE London
supported by NHSE funding.
• 2015/16 : collaborative approach to data collection to improve economic
evaluation and document cost savings across NCL and NWL.
• Future developments: Joint review of patients within the community
supported by CHC has potential to prevent secondary complications and
achieve further cost savings.
Some ways we hope to measure success
Contribution towards NWL target of reduction of Delayed Transfer of Care by 85%
Patient satisfaction
Clinician satisfaction
Contribution to reduction in Average Length of Stay in Neuro-Rehab services
Influence on level of neuro-rehabilitation required
Suggestion for service improvement/ development
Reduction in referral time to assessment (target 7 days) – level 2/3
Reduction in referral time to admission (target 14 days)-level 2/3 10