Storyboard submission Follow the detailed instructions in this template for writing a description of your storyboard. Type your information in each section below and save this completed storyboard document as a Microsoft Word file. Please spell check your storyboard before submission as it will be published on the NHS Wales Awards website. Please note: The storyboard should be between 500 1000 words maximum (including references but excluding headings, images or graphs) Submit your storyboard using the online submission system at www.eventsforce.net/nhsawards2013 by Friday 25 January 2013. Storyboard submission 1. Storyboard Title Swansea Acute GP Unit: Alternative pathways to hospital admission mean more choice and quality care for patients. 2. Brief Outline of Context (Where this improvement work was done; what sort of unit/department; what staff/client groups were involved) The Swansea Acute GP Unit (AGPU) was launched in Singleton Hospital in June 2012. Led by Dr. Chris Johns and Dr. Chris Hudson, AGPU is a unique service in NHS Wales, offering alternative patient pathways to acute hospital admission during an episode of urgent care.
AGPU takes a bold step towards service integration, acting as an interface between primary and secondary care services by delivering a GP triage of all GP referrals to the acute medical intake at Singleton Hospital and arranging patients into appropriate clinical pathways at the point of telephone triage or following face to face patient consultation. The service is staffed by local Swansea GP s who work closely with physicians, consultants, therapists and nurse assessors in Singleton to find the most appropriate outcome for each patient, ensuring that the patient has an informed choice about their most appropriate care pathway and that decisions are made with them, rather than for them. The community GP also receives a discharge summary within 24 hours. Following a GP call, if the Acute GP decides that the patient requires admission, they attend the Singleton Assessment Unit (SAU) directly to undergo observations and assessments to determine the best course of care or treatment. Alternatively, the patient attends AGPU for further assessment, and if appropriate, the Acute GP works with various groups to find an alternative pathway to admission, such as referral to the Community Resource Team (a mutli-disciplinary team that provides packages of care to patients out in the community), access to specialist Hot Clinics, immediate diagnostic investigation or consultant advice. AGPU promotes greater interaction and better working relationships between GP s and hospital physicians while challenging traditional ways of working by bridging the gaps between primary and secondary care.
Flow chart demonstrating the AGPU service: GP IDENTIFIES NEED TO REFER PATIENT TO SINGLETON HOSPITAL GP rings the receptionist of the Acute GP unit, who takes patient demographic details then passes call straight onto GP on duty Discussion between referring GP and Acute Unit GP Patient clearly needs admission to hospital Patient suitable for alternative pathway of care GP accepts referral on behalf of medical on call team (acute unit GP completes call record and this is faxed back to surgery GP faxes referral letter to 01792 298347 or gives letter to patient Patient suitable for: Urgent outpatient assessment by specialist services; OR Admission to a community nursing home; OR Care at home by the acute Community Resource Team; OR Short term support at home using social services / Community Resource Team Patient suitable for management by acute unit GP GP faxes referral letter to 01792 298347 or gives letter to patient Patient arrives at Singleton and transferred around direct to medical on-call team Patient admitted to hospital Acute unit GP facilitates access to alternative pathway & record faxed to GP to confirm Patient discharged home Acute GP sees patient, investigates as appropriate, develops management plan Patient commences on ambulatory pathway 3. Brief Outline of Problem (Statement of problem; how they set out to tackle it; how it affected patient/client care) Before AGPU, GP referrals to Singleton meant that patients were immediately sent to SAU. However, many patients did not really need hospital admission because they could have been treated as effectively somewhere else i.e. in the community or by a visit to an outpatient clinic.
Unnecessary medical admissions have negative impacts on patient care, as research demonstrates that many patients do not want to be admitted and recover quicker at home in familiar settings. Preventable admissions are also highly inefficient, creating unnecessary strains on secondary care resources. Therefore, it was decided that alternative care pathways need to be available for GPreferred patients to prevent unnecessary admissions to SAU. 4. Assessment of Problem and Analysis of its Causes (Quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements) Direct attendances at SAU following GP referrals to Singleton were identified as unsustainable due to the high number of unnecessary attendances, leading to strains on secondary care services. Also, many patients were not receiving the most appropriate type of care for their needs, such as care in the community over hospital admission. The model also created a lack of trust between primary and secondary care professionals because community GP s were often ill-informed about the patient s outcome following admission. To resolve these problems, it was decided that a new service model would be developed. The new model had the aim of offering alternatives to admissions, quicker access to higher level investigation, advice and second opinion, and quicker access to specialist advice. A key feature of the model would also be the speedy communication of discharge summaries to the referring GP s to ensure they are kept informed about their patient. 5. Strategy for Change (How the proposed change was implemented; clear client or staff group described; explain how they disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change) The decision to implement the change was made at the end of February 2012, and the service opened mid-june 2012. Nursing staff and GP s were informed about the new service and kept updated about the service developments via newsletters. A website was also set up to keep staff informed about AGPU (www.swanseaacutegp.co.uk). It was decided that the unit needed to be close to diagnostic services and the admissions unit, and delivered in an outpatient environment. Therefore, the service was placed in the same area as the current Minor Injuries Unit (MIU), which treats unexpected and urgent minor injuries or illness when a patient just can t wait to see
their GP. AGPU operates in parallel with MIU. It was decided that AGPU would be an integrated service with SAU, and that staff would work across both units, with one extra GP in MIU during AGPU operational hours. The service is operational from 8.30am-5.30pm, Monday-Friday. As an evolving service, the Acute GP s will work to keep developing new pathways. 6. Measurement of Improvement (Details of how the effects of the planned changes were measured) As AGPU was designed to reduce unnecessary medical admissions from GP referrals, the success of the service was measured by the number of GP s accessing the service, the number of medical admissions that were avoided through the service and patient feedback. 7. Effects of Changes (Statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes) AGPU has lead to significant reductions in the number of GP medical admissions. At present, one in three GP calls to AGPU does not result in an admission to an acute medical bed. AGPU is also being effectively utilised by GP s. Within three months, there were a total of 974 GP calls to AGPU, with an average of 25 referral calls per day. From 03 September 2012 when Neath and Port Talbot GP s also began accessing the service following the closure of acute medical services at Neath Port Talbot Hospital, there have been 1470 calls within three months. Overall, the alternative pathways offered by AGPU have resulted in 37% fewer attendances at SAU. AGPU s Clinical Lead has also reported that on some days, there are up to 50% reductions in GP medical admissions. Considering that before AGPU existed, almost all GP referrals resulted in attendances at SAU, these figures are substantial, and indicate that more patients are receiving the care that is most appropriate for them. The community of GP s were supportive during and following the set up of AGPU, as they seemed to recognise that the Acute GP s were working for and with them. There have also been no patient complaints about the service so far, and many patients have sent formal compliments to the department, with one patient stating that although working under pressure, the team work was marvellous.
8. Lessons Learnt (Statement of lessons learnt from the work; what would be done differently next time) AGPU has taught us that it is possible to challenge and improve traditional ways of working, and that the service is not a finished product but a stepping-stone towards the integration of primary and secondary care services. However, it important that Acute GP s are careful not to lose sight of their role as a GP by maintaining their own best practice and not that of hospital physicians. 9. Message for Others (Statement of the main message they would like to convey to others, based on the experience described) Improved patient care, increased efficiency and greater working relationships and cooperation between primary and secondary care professionals can be achieved when we work together and accomplish things across the boundaries.