The Urgent Care Conundrum The importance of Information and Technology Mark Newton MSc Head of Service Urgent Care NWAS NHS Trust Consultant Paramedic
Informatics: So what s it all about? Deals with the resources, devices, and methods required to optimise the acquisition, storage, retrieval, and use of information in health and biomedicine.
In my simple mind..it is about Right Information Right Time Right Place sounds familiar
What is Urgent Care? The delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment. the range of responses that health and care services provide to people who require - or who perceive the need for - urgent advice, care, treatment or diagnosis.
So what s all the fuss about.
Setting the Scene In 2012/13 there were 5.3 million emergency admissions to hospitals, representing 67% of the bed days in England and costing 12.5 billion. This represents a 47% increase over the previous 15 years Ambulance Services cost approximately 2% of NHS budget, but have a direct impact on 22%! We are operating in a restricted cost envelope where we are being challenged to do more, at a higher quality, for less. We are operating in a changing commissioning landscape
Whilst at the same time. These are under extreme pressure And in many cases reconfiguring in order to meet national standards
And what is the 999 impact. 9.1 million calls to 999, resulting in 7 million emergency responses 2.7 million responses to category Red responses (38.6%)-up 50% since 2007/8 but were they really red? 5 million ambulance journeys to A&E, 4.5 million of which were to a Type 1 or 2 A&E. (up 18% since 2007/8) Of the 4.5 million, 2.2 million (49%) ended up in one of these.. 74% of admissions were over 65 years of age * (Source:NAO 2013)
The Result
So what are the challenges? Population growth of 4.3 million by 2022 with more births than deaths.. (Source ONS 2012)
The number of people over 80 will double by 2037 to 6 million As we get older, we inevitably have more long term health problems In a recent pilot 70% of patients referred into alternative pathways of care were over 65 years of age
Did you know that as many as 1 in 5 of the patients admitted are known to the system and may have underlying chronic health problems that could be treated in the community In 2013 That's a possible 440,000 patients that could be managed by ambulance services through alternative pathways of care
The Current View In order to enhance the overall system of emergency care in England, ambulance services should be regarded as a care provider and not a service that simply readies patients for journeys to hospital (HCR 2013). Ambulance services must demonstrate a commitment to regard conveyance to an emergency department as only one of a range of clinical options open to them.(hcr 2013) Ultimately, the ambulance service has the potential to coordinate other elements of the emergency and urgent care system and lead integration of services (HCR 2013). If we take away Urgent Care and look at the true number of emergencies, there has been an increase of just 1.7% each year over the past decade. The population has risen by the same amount; in other words it has flatlined. The real increase is in urgent care related conditions (RCGP 2013).
Keogh Phase 1 Report
Keogh- Challenges & Barriers The system-wide transformation of urgent and emergency care services we envisage is a major undertaking. There will be many challenges along the way. Traditional barriers and vested interests will need to be tackled and broken down. Many parts of the system are already coping with sustained pressure and multiple demands, particularly GP practices which have themselves experienced significant increases in patient consultations in recent years. So, it will be important that we create the right conditions and environment to allow the new services to be developed safely
This is what Urgent Care feels like to most people?
So what can information tell us? People s health in the North West is generally worse that the England average Inequalities in the North West are closely related to deprivation Early death rates from heart disease and stroke and all-age all-cause mortality in the North West remain above the England average Child health is generally worse than the England average Hospital admissions related to alcohol are higher than average The number of smoking mothers is higher as is the average number of decayed teeth in under fives We have the second highest rate of hospital stays related to alcohol and deaths from smoking Ribble Valley and Cheshire East are the places to live, move immediately from Tameside or Liverpool The population is living longer and health is improving for many, not for all. Men will live 2.9 years less than those in the South East Women will live 2.5 years less than those in the South West The rate of incapacity benefit claims for mental illness in the North West is the highest in England In 2009 we knew that 62.8% of people in the North West experience a moderate level of wellbeing
AQI Turnaround Job Cycle Response Time ROSC Tail Analysis Hear and Treat/See and Treat Re-contact Rates 111-999 impact analysis Impact of early GP intervention analysis Advertising impact analysis Patient age and condition demographics And much much more Internal Information
Local Variations/Regional Context Information for each CCG against 32 health indicators We are a regional organisation but need to consider delivery in the context of local variation Information can assist us in determining resource type and allocation So I might consider preventative respiratory of cardiovascular strategies in Blackpool or Rochdale And perhaps some driving lessons or PE lessons in the Ribble Valley
Information and Innovation Are Reds Really Reds Are Triage Systems Sensitive and Specific Where are there gaps in service provision Collaboration and the sharing of information System Software and Hardware Support e.g ERISS
Secure electronic notification of referral information to other service providers Pre-defined, searchable pathways based on patient s postcode or GP Practice Registered users easy to set up account Secure portal for organisations to inform NWAS of care planning information & enable creation of alert flags Automated reminder system to prompt review of care planning information Fully configurable reporting and 100% audit trail System Support
One of the most important numbers in my phonebook!! The HI Department are critical in helping us: Understand our demand Integral to the development of delivery solutions Providing snapshots of daily, weekly, monthly or even hourly performance. They are an enabler in integrating emergency and urgent care They give us and commissioners confidence in knowing what works and what doesn t They are so Money supermarket!!!!
Innovation supported by Informatics and IT Pathfinder (HSJ Award Winning) GP/Acute Visiting Services Omega Strategy Community Care Plans Red Management Strategy ERISS and Clinical Support Hub
The Benefits
Thank you