7023 tf039 care home ward rounds poster 2012 jul
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Nursing and residential care homes care for vulnerable patients with health and support needs. One GP practice implemented a initiative where community matrons visited care homes proactively and in response to calls, providing clinical support. This decreased GP visits to care homes by over 50% and likely decreased hospital admissions and costs based on the successful practice. Surveys found patients, families, and care home staff were satisfied with the quality of care and support from the community matrons.
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7023 tf039 care home ward rounds poster 2012 jul
- 1. What we did What we found Nursing and residential care homes look after our sickest and most vulnerable patients, those most in need of personal, health and emotional support. Easington has a higher proportion of patients in care homes than the rest of Durham, and we noticed high levels of admissions, A&E attendance and use of Urgent Care Centres. We designed a pilot to cover 400 care home beds (covering both nursing and residential care) in the Seaham and Murton area (north of Easington district). In the previous 12 months (Sept 2010 to Aug 2011), 254 occupied beds resulted in 202 A&E attendances (80 per 100 occupied bed per 12 months) and 190 admissions (75 per occupied bed). These cost the commissioner a total of £582,846, or £2,295 per occupied bed. One GP practice stands out from the crowd – residents say the care is excellent, the numbers of A&E attendance and admission are much lower (cost per resident £1,495 per year or 35% discount on the average), and the practice makes an extra effort for elderly people in care homes. This practice asked for funding to run an initiative to for community matrons to visit care homes proactively, providing the senior clinical input The initiative started in the first week of March 2012, with the three part-time Community Matrons (total 66hrs/week) introducing themselves to each of the 5 GP practices and 8 care homes within the scope of this pilot. The service rapidly settled down, and although GP practices only keep a record of GP visits and not of calls to the practice, anecdotally they say that care homes have stopped calling the GP practices because they know they can wait until the community matron’s next visit. GP workload GPs are being called out to care homes far less frequently since the service began (from 32.2 visits/ week, to 11.3 visits/ week – see SPC I-MR chart). GP practices are united in their praise – the patient information faxed to them is comprehensive and complete, the patients and their families are happy with the care provided, and care homes no longer call for every little upset. We sent out and analysed surveys to a wide range of stakeholders including care home staff, GPs and GP practice staff. Patient Experience Patient survey confirms that the initiative is well received. 100% of patients and families are positive about the quality of care they receive and their confidence in the community matrons. Care home staff have also responded extremely positively. Courses have been run for care home staff in diabetes, nutrition, dementia, infection control, inhaler use and catheter care. Staff turnover in care homes is usually high, but many staff move to another care home within the area so the training is not lost. Staff appreciate the support they get from the community matrons who have time to explain things. Use of Hospital NHS hospital attendance and admission data and ambulance conveyance data are delayed for data quality reasons, so it has not been possible to get definitive figures in the time available. An estimate of the hospital savings is based on the difference between the successful practice which is running this service, and the average, which would give a 35% saving overall. This would be £205,996 over 12 months. This compares well with the cost of employing the three part-time Community Matrons at £94,084 over the same period – saving over 2* as much as the cost. This may be an underestimate as the Community Matrons are able to spend much more time with the patients than the GP could, and for example there were only two admissions across all 300 residents during the 4 day Jubilee Bank Holiday weekend. Activity In the 4 months to date, the Community Matrons have done 1,202 visits and delivered a whole range of education and courses to care home staff. Even ignoring the courses, this works out at £26.09 per visit—with the courses it could calculate at just over than half of this amount. The aim of the project is to improve quality of life and health for patients in residential and nursing homes, which in turn : Decreases the demands on GP practices to attend the homes for what in many cases turn out to be minor incidents Decreases disruption to patients by reducing the need for emergency hospital attend- ances and admissions Reduces overall costs to the commission- er, which will be reflected in the GP prac- tice indicative budgets and Clinical Com- missioning Group budget Community Nurses (employed by the practice with the excellent results) visit each care home BOTH when the care home places a call with the GP practice (care homes do not have the facility to contact the community matrons direct- ly), and on a proactive basis at least twice per week on specified dates and times. The Com- munity Matrons see any patient who requests, meet family, and train care home staff on re- quest and at their own discretion (eg if a cathe- ter has become infected at one care home, the community matron may organise a catheter care training course for staff at the home). The Community Matrons work within their compe- tence, and ask the supervising GP if there is an- ything they are unsure about. If medication needs changing or a patient needs admission to hospital, then the community matrons (who are all independent prescribers) refer the patient back to their own GP with a recommendation. The patient’s own GP is kept informed and has ultimate responsibility, but the community ma- trons take a lot of the workload. With thanks for continued contributions from so many people, and especially recognising: Dr Chandra Sirapurapu, Pat Jobson, Hugo Minney, Ann Brown, Liz Willis, Gail Dryden, Christine Scollen, Carol Hardy, Joseph Chandy and many others. Hugo Minney authored the poster Patient or staff concern, illness, injury, disorder Within nurse competence Lead GP offers advice & support Nurse takes action Yes No Nurse regular proactive visit or on request Within nurse competence Patient’s own GP makes decision Yes No Review or discussion Care Home calls GP surgery Nurse informs Pt’s own GP Change of medication or Hospital admission Care in the home Care Home Ward Rounds Stakeholder Experience Surveys