As part of the Better Local Care vanguard project to support professionals working to provide specialist care closer to home, Southern Health NHS Foundation Trust, South Central Ambulance Service (SCAS) and care home staff are working together to look at the reasons why care homes make calls to emergency services and finding ways to reduce these. Staff from Southern Health’s multidisciplinary care home team, together with a SCAS paramedic identified the top 20 care homes in Fareham, Gosport and south east Hampshire who were high users of 999 but the patients were not being admitted. By focusing on these care homes, they were able to identify areas where they could make a difference.
Keeping residents as well as possible by ensuring any ailments or conditions are dealt with minimal delay prevents them from developing more complex health care needs which may require admission to hospital. Care home staff received training on fall prevention, seating positions, pressure ulcers, urinary infections, hydration and nutrition and advised how to recognise earlier signs of these issues which would have an effect on health.
The Multidisciplinary care home team, which includes registered mental health nurse, senior occupational therapist, community matron and healthcare workers, worked with the homes to assess and treat residents without the need for a GP referral, ensuring those who need the service received it when they needed it most, often preventing conditions getting worse and needing further treatment.
The pilot also highlighted the benefits of care homes by contacting a duty GP via the direct line to a GP, by-passing reception, which staff could call with any urgent concerns about a particular resident.
They have also worked closely with SCAS to make end of life care plans robust enough to be acted upon by all healthcare workers, including instructions for Do Not Resuscitate and to ensure the wishes of the patient are adhered to.
The pilot has resulted in a significant reduction in both the number of calls to 999 (by some 39.1%) and the number of residents admitted to hospital of some 22.3%. At one particular care home between July and September, 18 calls were made, of which 10 resulted in admission to A&E; October and December the same care home made only 5 calls of which 3 were admitted to A&E; showing both a reduction in callouts, but also that those calls which were made, were more likely to require admission which meant the callout was the right decision to make on those occasions.
Janine Harriman, Community Matron for SHFT care homes team explains that “by working more closely with care homes we have been able to better understand the issues and work with them to rectify, providing training, support and therapy in a more joined up, timely manner. It has had a very positive impact not only on the residents who we provide care for but also to the staff who support those residents”.
Terri Gamble, a demand practitioner paramedic from SCAS comments that” The way forward is communication, and we have achieved this not only as a team of professionals but in the delivery of our work to the care homes, this has had a significant impact on the reduction of 999 calls and the more appropriate use of 111, thus preventing admissions to hospital.”
Donal Collins, GP lead for Gosport says “This is exactly what Better Local Care ethos is about, recognising an issue in the way healthcare is delivered or used, and looking a new smarter ways of delivering it without unnecessary burden on our emergency services. This pilot has benefited the lives of those living in care homes, by ensuring the staff are equipped to manage their ailments and illnesses in the home.”
Brook Lane Rest Home is involved in this pilot and is delighted with the impact it has had not only on the residents, but also on staff. Like many other homes, they previously relied on calling 999 for emergency help with residents and GP referrals to therapy services meant residents had to wait a few weeks before treatment, when often they needed that care sooner. Both issues have been addressed via training for staff and direct access to the occupational therapist, without the need for a GP referral.
Emma Dale, Manager at Brook Lane Rest Home, says that “having Sue (occupational therapist) here has made such a difference. She understand what we are trying to achieve, gives us a way of doing things differently, looking at new exercises, she takes the time to train our staff up to make them more aware of how to keep our residents as mobile as they can without overstretching them. She has worked so well with the residents and their families, by being able to offer assessment and treatment so much quicker than waiting for a lengthy referral.”
Plans to evaluate the pilot are currently underway with the prospect of rolling this model out across more care homes in the area.
This pilot is part of the Better Local Care vanguard project to support professionals working to provide specialist care closer to home.