The aim of the project was to change the behaviour of a specific cohort of patients by understanding their needs, and putting additional support in place to provide them with an alternative to having to attend A&E.
The clinicians leading on this work were Mr Kay Adeboye, A&E Clinical Lead and Viv Priestley, the Urgent and Emergency Care Operational Manager, with fantastic administrative support from Jo Tiplady, Data and Quality Co-ordinator. It would not have been successful without the multi-disciplinary input including that of Dr Wallace, Joanne Marr from the North East Ambulance Service, the Adult Safeguarding Team and representatives from wards, in partnership with Liaison Psychiatry colleagues Fiona Craig, Advanced Nurse Practitioner, Eve Newbury Team Manager and Elaine Wells Service Manager from TEWV NHS FT.
The work involved an in depth analysis of people arriving at A&E with identified/unidentified mental health needs presenting with challenging behaviour. The team then considered all of the necessary adjustments that needed to be put in place to support these individuals. For this strand of work, the opportunity to collaborate on site with colleagues from Tees Esk and Wear Valleys NHS Foundation Trust, NEAS and Cleveland Police was invaluable. This included all Trust Directorates and drug and alcohol service colleagues too.
This tailored care is a great example of the innovative work that goes on every day within the Trust. The team have established a model of work which allows the patient to co-design their detailed care plan to meet their individual needs.
Mr Kay Adeboye, Clinical Lead for A&E explains ‘this is a really important piece of work that began as a CQUIN target but has since become embedded and is part of the everyday good practice within our A&E. To make the programme work, we put in place a meeting with representatives from cross-organisations where we are able to discuss attendances on a case by case basis, with the relevant professional input. This is something that is now business as usual and has proven very useful for all parties involved.
The aim of this work was to prove the effectiveness of joint working with external and internal services to provide a high level of support to those patients identified, taking a pro-active approach to managing the needs of those patients and ensuring they receive safe care. In fact this resulted in an improved patient journey by ensuring that every patient received the best possible care in the right place at the right time, having a positive impact on overall patient experience and clinical outcomes.’
To pilot the work, 25 patients were identified as the cohort of people who frequently attended A&E. In total, they attended A&E 389 times between 1 April 2017 to 31 March 2018. The milestone required a 20% reduction in 2018/19 from the baseline levels in 2017/18, which would mean reducing those to 311 attendances.
In Y2 the total number of attendances has fallen for 1 April 2018 to 31 March 2019 to 171 which is an overall 56.04% reduction in attendances. These numbers are really impressive and the team have been able to maintain and improve upon this reduction in attendance of the identified cohort of patients.
Eve Newbury, Team Manager for Psychiatry Liaison at TEWV added ‘the achievement of this CQUIN is a result of building on work around high intensity users of services and the commitment to partnership working from everyone involved. We have been able to identify service users and invite them to co-produce personalised care plans allowing them to access the right care in the right place at the right time. These plans allow for a greater understanding of an individual, allowing us to identify their unmet needs so we can signpost them to the most appropriate service consequently reducing attendance at A&E. We hope this work continues and I look forward to seeing what developments the next year will bring.’