AIMS
This study aims to map the acute presentations made by patients attending hospital and model any changes to the care pathways to help develop better services for patients.
BACKGROUND
There are a rising number of patients presenting to hospitals for acute or unplanned health care. Hospital pathways are designed to admit patients who are more unwell or who are frail and need in-patient care, and discharge those who can be managed in the community. Some patients are finding it difficult to see their GP or access community care; at the same time, more and more people are turning to hospitals to access medications or medical advice. Currently over 60% of patients attending the Emergency Department (ED) (which is approximately 3 million per year in England alone) are discharged without invasive tests or medications and within a matter of hours. It is likely these patients could have received their care in a different setting such as their GPs or community services.
NHS England is encouraging NHS hospitals to think of new ways to deliver care to reduce the burden on Emergency Departments, using Same Day Emergency Care systems, virtual wards or even by setting up their own GP practices which can see patients referred directly from ED.
These sound like sensible suggestions, but every new hospital care pathway impacts on current healthcare delivery, as there are only a certain number of doctors, nurses and hospital clinic rooms within each hospital. Diverting care to a new system means reducing care from a current service. It is important to ensure any new services have the impact required and that they are safe, valued by patients and protect usual NHS services. It is important to get the selection criteria right for each of these services, to avoid the wrong patient being sent for the wrong service.
Currently, there is no information to help build these services, and then test their impact once they are up and running. This project has been designed as an urgent assessment, in collaboration with NHS England, to build and test new services to reduce the number of patients being seen in ED.
RESEARCH
This project will first describe usual care practices for patients presenting to UHB (all 3 hospitals), their symptoms, admission journeys, diagnoses and flows. Then these data will be used to model different selection criteria for SDEC, in-house GP services or virtual wards, to determine which criteria would remove the most patients from ED without causing an unacceptable rise in likely readmissions or adverse patient outcomes
The researchers aim to describe current patient flow through hospital from GP referrals and the admissions department, assessing in particular what groups of patients were in hospitals for a short period of time, to help determine if alterative services could be offered for them.
They also plan to model any proposed changes to which patients are suggested for assessment through other acute services (same day emergency care (SDEC) or an in-house GP service), to determine what proportion of patients might be eligible for these services and what their likely outcomes would be.
PATIENT INVOLVEMENT
The researchers have spoken to patients admitted to hospital, including those waiting in the Emergency Department. Conversations involved potential new services, the involvement of patients in developing and evaluating new services and giving a patient perspective when the new services are designed and built.
APPROVAL
This project was supported unanimously by the PIONEER Data Trust Committee.
This work is led by Professor Simon Ball, Consultant Nephrologist at University Hospitals Birmingham NHS Foundation Trust.
