Working with GPs and Care Home staff to reduce emergency hospital admissions

R Lisk, K Yeong, A Nasim, B Mandal, R Nari, Z Dhakam presented their research at the Autumn conference of the British Geriatrics Society. Reblogged from the British Geriatrics Society blogshutterstock_45287182

Residents of Care Homes with Nursing tend to be frail, have multiple diagnoses and high levels of dependency.  This results in complex care needs. Many experience multiple admissions to hospital, often with long lengths of stay.

This initiative was aimed at reducing the number of emergency admissions to our Trust from local Care Homes with Nursing, by working in partnership with staff in the homes and local GPs.  The aim was to help provide more bespoke care for this vulnerable patient group, keeping them out of hospital whenever it was possible and appropriate to do so.  The project was also part of a Trust-wide response to the new emergency admission cap introduced through the National Operating Framework 2010/11.

Initially we chose to work with the three nursing homes with the highest multiple admissions according to their capacity.

Consultant Geriatricians visited the Care Home managers & GPs to listen to them to see how they thought we could help them reduce hospital admissions. So we started from the perspective of working in partnership. They suggested the following interventions which were used for the project:

To reduce admissions:

  • Medical Advisory Meetings with GPs: – the consultant geriatrician would meet with the GP and the nursing home manager monthly, at the care home, in order to discuss residents and evaluate those that needed medical input – a two hour meeting.
  • Availability of telephone advice (Mon – Fri 9am to 5pm) from a hospital consultant
  • To use Medihome – a private healthcare company – to provide intravenous antibiotics and fluids to the three care homes in the project.
  • End of Life Care – to liaise with GPs regarding residents about End of Life Care and facilitate advance care planning.

To reduce the length of stay:

  • The trust IT department set up an email alert system to inform the consultant geriatricians whenever a resident from one of these 3 nursing homes was admitted to hospital. On receipt of that alert, geriatricians would review the resident and liaise with the nursing home manager and GP to expedite discharge.

Here are some comments from our partners:

 “It is not something I have come across previously, the only ward rounds I have done have been quite haphazard, did not have any structure to it; it is quite good seeing that things which are usually managed in an emergency setting can be dealt with in the community and this also enabled staff to deal with complex patients and be able to manage them quite comfortable within the care home setting”

General Practitioner

“We get specialised care from consultants coming into the care home and it enables are residents to stay within the home.”

Nursing Home Manager

“When father had an infection they would put him on an intravenous drip with antibiotics in it, just as if he was in hospital, but unlike being in hospital, he had the same nursing staff that he was familiar with and who were also familiar with his other conditions”

Service user relative

This excellent video shows more views from service users

There was a 52% reduction in emergency admissions in the first 3 months for 3 care homes. A further 43% reduction in the next 4 months for 6 care homes and  further reduction of 250 bed days over this period compared to the year before. There was a 35% reduction for 12 care homes.

Following this successful innovative nursing home project, our Trust set out to provide a regular care home liaison service which covered 12 care homes with nursing.   This service uses the 4 key interventions described to reduce emergency admissions and the one intervention to reduce length of stay once admitted.

Due to the success of this project, the North West Surrey (NWS) Clinical Commisioning Group has developed a NWS Care Homes Project Steering Group which has enabled the GPs to take the lead role in carrying out the above interventions with telephone advice as necessary from geriatricians. This recognised efficiencies have been maintained (April 2012 – March 2013) this financial year as despite the GPs taking the lead from Oct 2012.