The Emergency Care Intensive Support Team (ECIST) Driving Improvement along Emergency Care Pathways: A Master Class

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1 The Emergency Care Intensive Support Team (ECIST) Driving Improvement along Emergency Care Pathways: A Master Class WORKSHOP INFORMATION Morning Workshops (Workshops 1-4) Delegates have a choice of two workshops within the morning session. You will be able to select which workshop to attend on the day of the event. WORKSHOP TITLE Workshop 1: Creating a sustainable model for Community Workshop 2: Developing a Rapid Assessment and Treatment Model SPEAKERS & ROOM ALLOCATION David Carson, Director, Primary Care Foundation George Fox Lisa Niklaus, Consultant in Emergency Newham Hospital Tony Joy, Darzi Fellow in Clinical Leadership & Registrar in Emergency Medicine William Penn WORKSHOP SYNOPSES Community hospitals are a vital part of the urgent care pathway. In this piece of work the Primary Care Foundation took an approach which focused on building a model to include Community Hospital facilities as a part of on-going local provision. The workshop will include: What the Primary Care Foundation were asked to do How we did it Where we got to The key impact of the Clinical Model on Community Hospital provision The aim of Rapid Assessment and Treatment (RAT) is to provide early senior clinical assessment of undifferentiated Emergency Department patients. The approach can work alongside or in place of triage and aims to deliver more streamlined care, where the first doctor a patient sees is a consultant or registrar who is able to make an accurate initial assessment, define a care plan and identify whether the patient requires admission or referral to an in-taking specialist team. RAT helps to identify sick patients early, and delivers more timely investigations and management. It also facilitates seeing and treating patients who may have minor complaints and do not require further investigations which could delay their discharge. The model has been implemented by a number of emergency departments and demonstrated benefits to patient safety and patient satisfaction, as well as departmental flow and resource management. The model also provides a means by which Emergency Departments (ED) can achieve both their time to assessment and time to treatment A&E Clinical Quality Indicators.

2 Workshop 3: Interface geriatrics: implementing early assertive pathways Simon Conroy, Head of Service /Senior Lecturer in Geriatric Leicester Elizabeth Fry Implementation of RAT can be difficult. Senior clinicians who lead RAT teams can find the intensity of work a challenge, and both high patient volume and limited flow out of the ED can present further difficulties. The workshop will describe Newham Hospital s experience of implementing a RAT model and will include: The theory behind a Rapid Assessment and Treatment (RAT) model Newham s approach to implementing a RAT model What worked for us On-going challenges Health and social care systems are starting to experience the boom in the oldest old. Much of the focus in recent times has been on hospital admissions and how to prevent them. However, preventing hospital admissions is not easy, and several large scale projects targeting older people with varying levels of risk of admission have not been as successful as expected in demonstrating clinical or costeffectiveness. Traditionally emergency departments have not focussed on older people, this combined with the 4 hour (attendance to dispersal) standard mean that the conversion rate (proportion attending that are admitted) can be higher in the oldest old compared to any other group. Leicester has introduced a Frail Older Peoples Service to begin to address some of these challenges. The workshop will describe this initiative and include: A focus on the acute hospital s initial response to older people attending Emergency Departments. Introducing the principles of Comprehensive Geriatric Assessment into the emergency care axis. Re-establishing the link between primary secondary care, essentially re-introducing the G of CGA into emergency, acute and community care of older people. Workshop 4: Delivering sustained reductions in internal waits within an acute trust Liz Williamson, Deputy Programme Director, Better for You Scott Purser, The need to reduce internal waits is a challenge faced by all hospitals as long internal waits create delays for patients along their pathway. A healthy and efficient service for patients requires hospitals to reduce their internal waiting times. Nottingham has been successfully using their Better for You programme to drive improvements and increase efficiency. The initiative s overarching objectives are to

3 Project Lead, Reducing Internal Waits, Nottingham Main Meeting House reduce unnecessary waiting and improve safety and the patient experience whilst supporting Cost Improvement Plans. The aim was to reduce internal waits by between 50 and 80%. The workshop will include: Background Nottingham, Better for You programme Discovery phase - why the issue was important Developing the toolkit; implementation overview of the rollout programme Impact of the changes Continuous Improvement adapting, refining, improving the toolkit Reflections Afternoon Workshops (Workshops 5-8) Delegates have a choice of one workshop only in the afternoon session. You will be able to select which workshop to attend on the day of the event. WORKSHOP TITLE Workshop 5: The RAID model: integrating mental health and general acute care at the front door Speakers & ROOM ALLOCATION George Tadros, Consultant and Lead Clinician for RAID, Birmingham & Solihull Mental Health Trust Main Meeting House WORKSHOP SYNOPSES The Rapid Assessment, Intervention and Discharge Service (RAID) is a new model of care which is both innovative and integrated. RAID aims to respond to hospital needs to support early and appropriate discharge. RAID has been evaluated by the London School of Economics who recommended the model to the NHS Confederation in A number of sites across the country are now either planning or implementing similar models of care. The workshop will include: What is RAID? Evidence of need: General Psychiatry, Alcohol & Substance Misuse and Older People Where is RAID? Who is in the RAID team? Focus on training Evaluation of benefits

4 Workshop 6: Implementing Patient Gateways to improve emergency flow within Respiratory Services Workshop 7: Utilising Therapy services to improve discharge planning Brian Bradley, Consultant Clinical Lead, Respiratory Royal Bolton Hospital Michaela Bowden, Respiratory Nurse Specialist Cindy Walton Senior, BICS Facilitator George Fox Christina Richards, Head of Therapies & Stroke Services Anne McLaughlin, Senior Physiotherapist Nicola Higginson, Senior Occupational Therapist William Penn Bolton has been pioneering the use of lean in healthcare since 2005 through the Bolton Improving Care System with significant success particularly across the respiratory pathway. They have used the one decision flow method to apply lean principles to improving patient care and developed local patient gateways. This initiative has supported timely and appropriate multi-disciplinary clinical decision-making and reduced delays in the patient journey. Changes have included: daily consultant and multidisciplinary review in the week; improved discharge planning for weekend discharges; respiratory specialist nurses working seven days per week and implementing a pull system to support the early identification and treatment of respiratory patients. The workshop will include: Background Royal Bolton Hospital Improving Care System Brief introduction to Flow in Clinical Area linked to patient gateways What and how the Team changed: Inpatient Areas and Specialist Nurses Results from the changes The workshop will focus on how therapy services at West Middlesex Hospital have changed their practice within existing resources to assist the hospital in improving patient flow and discharge planning. The aim is to ensure that patients are assessed at the right time to minimise the length of stay for older adults in recognition of the detrimental effect a prolonged hospital admission can have on an older persons function. West Middlesex will set out how this initiative has improved patient care at the same time as it has supported increased job satisfaction for individual staff. The workshop will include: Context West Middlesex Brief introduction to key principles What and how the Therapy services changed Impact of the changes for patients and staff Key areas for other sites to consider

5 Workshop 8: Effective Integration of acute and community services for frail older people Bie Grobet, General Manager, Integrated Adult Services, South Warwickshire Elizabeth Fry South Warwickshire have developed the Cutting the Cost of Frailty programme, which has redesigned the pathway for frail older people across the acute and community services to reduce length of stay in the acute trust whilst enhancing outcomes and promoting independence for patients. The programme s principles are to: choose to admit only frail older people who have evidence of underlying life threatening illness or need for surgery; provide early access to an old age acute care specialist; discharge to assess as soon as the acute episode is complete; plan post-acute care in the person s own home; and provide comprehensive assessment and reablement during post-acute care to determine and reduce long-term care needs. These principles were recognised and highlighted by the Kings Fund in their publication Older People and Emergency Bed Use (August 2012). The workshop will include: Context within South Warwickshire Description of the key Cutting the Cost of Frailty principles What and how the Service changed Results from the changes

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