Frequent User Initiative. Paul Wildin Implementation Manager

Transcription

1 Frequent User Initiative Paul Wildin Implementation Manager

2 Overview Increased demand for Ambulance. Pressure to meet demand / response times. Small group of patients with high utilisation rates.

3 Frequent User Patients Uncoordinated care of lower quality Consume valuable acute care responses. Psycho-social vulnerabilities. High use is a predictor of life threatening illness. Rinke et al (2012) 20% mortality rate in Baltimore study of Ambulance frequent users, Sheridan (2013).

4 Developing a Frequent User Model No model of care for Frequent Users of Ambulance services in Australia. Limited evidence base to assist development of a model. Two UK services and a small number of US Fire Departments had trialled case management approaches.

5 Frequent User Model Definition: 10 emergency uses in a six month period. Any patient regardless of presenting problem. High Acuity Callers eliciting an emergency response.

6 Number of patients meeting definition of Frequent User / / /13

7 Number of Ambulance Uses by Frequent Users / / /13

8 Types of Frequent User Patients Enduring Episodic Acute.

9 Nov 1 st 2013 April 30 th 2014 Data Report Red patients (30+) 29pts, 1248 uses. Amber Patients (20-29) 32pts, 772 uses. Green Patients (10-19) 232pts, 2945 uses.

10 Identifying patients for intervention. Notify Patient Prioritise Referral Sources

11 Interventions - Assessment Functional Assessment of Ambulance Use Barriers to engagement. Medical history. Existing Service linkages. Co-morbidities. Psych-social factors / vulnerabilities. Health literacy.

12 Frequent User Interventions 1)Notification to existing care providers only. 2) Patient Signposting. 3) Development of a multiagency plan. 4)Designated Case Management. 5)Agreement of Appropriate Ambulance Use.

13 Case Management Interventions are carried out in the patients home environment and local community. Focus on working with barriers and addressing unmet need. Intervention is individualised and flexible.

14 Case Management Service Delivery Service Coordination Brokerage Psycho-Social

15 Case Management Caseload 35 active patients 12 receiving intensive case management (ICM) intervention. ICM seen face to face between 1 & 4 times per fortnight. All have received a comprehensive assessment. Administer General Health Questionnaire

16 Case Study

17 Case Study 2 48 year old female frequently calling with shortness of breath and chest pain. 50+ uses each year since uses in Low transport rate 35% of 2012 & 2013 uses resulted in transport to an ED. Rarely attended GP.

18 Patient Issues Significant self-neglect. Poor Health Literacy. Substance Dependence (Alcohol). Untreated anxiety disorders GAD, Panic Living in absolute squalor.

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23 What did the Frequent User team do? Engaged patient and undertook a comprehensive patient assessment. Engaged the Patients GP. Attempted to engage other care providers. Undertook a trial of case management. Worked with the patient on addressing her most immediate concerns / stressors. Delivered cognitive and behavioural interventions to assist patient manage stress and anxiety.

24 Case Study 25 Per month uses April 2013 April

25 Current Status Weekly home visits Linked in with local Drug Health Service for past 6 weeks. Increased appetite and mood (self reported) Motivated to further address long term areas of neglect.

26 Challenges Pt AM Pt BC May June July Aug Sept October Nov Dec Jan Feb Mar April April May June July Aug Sept October Nov Dec Jan Feb Mar April

27 Complex Patients PKR Albury Base Hospital 1 Auburn Hospital 3 Bankstown Hospital 5 Blacktown Hospital 5 Blue Mountains Hospital 1 Bowral Hospital 1 Campbelltown Hospital 2 Canowindra Hospital 1 Canterbury Hospital 3 Concord Hospital 2 Fairfield Hospital 1 Gosford Hospital 1 Goulburn Hospital 2 Hawkesbury Hospital 1 Hornsby Hospital 1 John Hunter Hospital 1 Liverpool Hospital 3 Maclean District Hospital 1 Nepean Hospital 7 Orange Health Service General Hospital 1 Prince Of Wales Hospital 3 Queanbeyan Hospital 2 Royal North Shore Hospital 2 Royal Prince Alfred Hospital 5 Shellharbour Hospital 2 Shoalhaven Hospital 2 St George Hospital 4 St Vincents Hospital 2 Sutherland Hospital 1 Wagga Wagga Hospital 1 Westmead Hospital 3 Wollongong Hospital 1 (blank) 13 Total 84

28 Limitations of Traditional Disease Management Models Patients are motivated Have the resources available to manage their health needs. Many patients are not eligible for existing services Patients attitudes / personality factors may impact on engagement with treatment providers.

29 Emerging Patient Groups Chronic Pain Untreated Anxiety Disorders Substance Misuse Intellectual Impairment

30 Role of the frequent user team Form relationship with patients. Understand the function of the patients behaviour. Formulate and Implement Intervention Strategies. Listen to the patients story. Engage with the patients support network.

31 The Future Increase Resources Complete economic evaluation Evaluate what s working. Develop stronger partnerships with stakeholders Publish outcomes

32 Frequently Used Ambulance Interventions following Multi-Agency Meetings Implementation of NSW Authorised Care Plans. Direction to administer / not administer specific treatments e.g avoid use opioid based analgesia. Direction to transfer to a designated facility. Decisions authorised by FU Clinical Governance Committee.