Ensuring better flow through our hospitals
Maintaining hospital “flow” is vital to ensuring that we are able to provide care this winter. Flow refers to all aspects of the patient’s journey through care, from initially reaching the hospital via ambulance, A&E or for an elective procedure, to their time as an inpatient in the hospital, to their discharge from hospital to another care setting or their place of residence. Without flow the system becomes blocked and it becomes much more difficult to admit people who need to be.
We’re putting measures in place this year to help keep ambulances on the road and available to respond to emergencies, find alternatives to A&E and to help people get out hospital as soon as they are well enough to do so.
Avoiding unnecessary admissions – same day emergency care (SDEC)
We want to safely avoid admitting people with urgent or emergency care needs into hospital when they could otherwise be treated and return to their own home on the same day. One of the many ways we are doing this is through same day emergency care (SDEC).
Same day emergency care units act as a half-way house between Emergency Departments (ED) and in-patient wards for certain conditions and treatments. These units allow hospital clinicians to triage, run tests, assess and treat patients all on the same day. This helps reduce patient waiting time in the Emergency Department as well as admissions to inpatient wards.
Most referrals to SDEC come either direct from ED or from the patient’s GP. Examples of conditions often managed in this way are:
- Deep vein thrombosis (DVT)
- Transient ischaemic attack (TIA), also known as mini-strokes
- Low risk chest pain
- Emergency intravenous drugs and fluids
- Emergency blood transfusions
Where needed, people return for follow-up treatments within the next few days. Locally, this can cover general medicine, older and frail people and can also be part of a surgical assessment area.
As part of the on-going work we are doing to reduce pressure on Emergency Departments, we are now working with hospitals in Coventry and Warwickshire to take this further and enable paramedics and the ambulance service to directly access SDEC areas. This will reduce the number of people who need to wait to be seen in ED and release the ambulance crew to take other calls as they will no longer have to wait with them.
We are also piloting a service where NHS 111 call assessors can refer direct to some of the SDEC areas for specific conditions. This will mean patients won’t need to wait to speak to a 111 clinician or be sent to ED. It is in the early stages but initial signs show it is having a positive impact. This is another part of the transformation work we are doing to help improve patient care.
Urgent Treatment Centres
Urgent Treatment Centres provide fast access to health advice and treatment for a wide range of minor illnesses and injuries.
You can access urgent care services by calling NHS 111. If the advisor thinks you need to be seen in person, they will advise you of local options and book an appointment for you if needed.
NHS 111 Online
NHS 111 is for when you need urgent, same day care and you are not sure what to do. You can access NHS 111 online.
Specially-trained advisors will ask you questions about your condition and direct you to the right healthcare service. If needed they can also book face-to-face appointments.
Supporting frail and older people return home safely – follow-up calls post-discharge
South Warwickshire University NHS Foundation Trust has made a significant reduction in the number of over-75s being readmitted after a hospital stay with a phone call.
This simple intervention reduced readmissions from 15% to 3% in the first 30 days after it was introduced.
The frailty team now calls all patients with a Warwickshire GP, aged 75 and over and leaving the Frailty Ward to return home, within 72 hours of discharge.
As well as checking on their health and how they are coping at home, the team also checks they are taking prescribed medicines, finds out it they have any concerns about remaining at home and provides them with information about services and support available to them. If they have any concerns about their health and wellbeing, a home visit is arranged.
The service works closely with the Warwickshire County Council and Warwickshire Fire and Rescue Service, meals providers, home assessment teams to provide additional aids and adaptations, Age UK, the Carers Trust and Mind.
This one simple intervention has already made a huge impact on both the patients and their families and carers.
All three acute hospital trusts across Coventry and Warwickshire now provide care via Virtual Wards. This involves a consultant-led service, supported by other clinical staff, to provide care equivalent to an inpatient stay for suitable patients in their own home. Some severely unwell patients are accepted to the service before they are admitted to a hospital bed (admission avoidance). Virtual Wards also allows some inpatients to finish their care episode at home (early supported discharge). The aim is to free up hospital beds for other patients for whom there is no reasonable alternative to hospital inpatient care.
Each patient is carefully assessed in terms of clinical and home suitability, patient safety considerations and consent. Patients (and/or carers) are provided with training plus equipment in their own home to take regular clinical observations e.g., temperature, heart rate, blood pressures. Internet enabled devices are also supplied to transmit the observation readings and if readings fall outside of safe levels, an alert is raised and managed accordingly by the patient's Virtual Ward Team. This usually involves a phone call to the patient but can also involve a home visit. Patients can also call the Virtual Wards Team direct if they have concerns or questions about their care. Some patients will receive home visits depending on their care needs.
All three providers have implemented Virtual Ward pathways for frailty and respiratory infection as per NHS England requirements. They can deploy additional local pathways depending on factors such as clinical capacity. For example, two providers deliver intravenous diuretic medication for heart failure patients presenting with excessive fluid retention.