Tackling hospital winter pressures

Helen Hunt, innovation programme manager (Workforce) at the West Midlands Academic Health Science Network explains how the NHS Insights Prioritisation Programme is helping to address winter pressures

According to the Royal College of Emergency Medicine, approximately 4,000 patients a day are currently experiencing waiting times of more than 12 hours in A&E. With the onset of cold weather and flu exacerbating these pressures, there has never been a more important time for us to reduce unavoidable hospital admissions.
    
What’s more, the cold weather and the illnesses it brings presents an increased risk to our elderly population. Hospital admissions of this nature contribute to the growing pressures on A&E departments.
    
To minimise these risks and reduce hospital admissions for the elderly population, the NHS Insights Prioritisation Programme (NIPP) is being implemented. The NIPP is designed to accelerate the evaluation and implementation of innovation that supports post-pandemic ways of working, builds service resilience and delivers benefits to patients.
    
The West Midlands Academic Health Science Network (WMAHSN) has been working alongside ARC West Midlands, as well as Sandwell and West Birmingham Foundation Trust and South Warwickshire Foundation Trust, who have implemented new models of care for admission avoidance for older people living with frailty.
    
In this region, two models of care for admission and conveyance avoidance have been identified. The first, which is the South Warwickshire model, utilises geriatrician outreach and enhanced rapid response community services. The second, known as the Epicentre model and used out of Sandwell and West Birmingham Hospital, relies more on point of care testing, such as hand-held ultrasound and blood testing.
    
Helen Hunt, innovation programme manager (Workforce) at the WMAHSN, is supporting the rollout of this innovative programme.

Can admission be avoided for older people living with frailty?
New models of care can work to ease the burden on hospitals and emergency services by addressing health inequalities and providing point of care testing in the home. This can be done through diagnostics and acute medical intervention, as well as enhanced support from community teams with input from secondary care.
    
Through this, the programme is working to avoid the conveyance of older patients with frailty to hospitals, as emergency departments are not the most appropriate setting to deal with this.

Supporting hospitals and emergency services
Delivering high-quality and frailty-attuned acute assessment and ongoing care outside congested acute hospitals is a very high priority for the NHS. These two solutions are being evaluated as part of the NIPP.
    
The average hourly cost of an ambulance unit is £500, and the West Midlands Ambulance Service responds to around 4,000 calls daily. Through this work, we are working to reduce this strain on emergency services and save vital costs in the process: giving back time and money.

Supporting the elderly population
No elderly patient wants to be admitted to hospital for minor ailments, and the new models of care support them in their wishes. By providing essential medical support in their homes, we can enable greater independence whilst improving overall safety and enabling them to safely stay in their own comfortable surroundings.
One reason elderly patients prefer to receive care at home is due to fears surrounding the length of hospital stay. As age increases, so does the length of stay in hospital; patients under 75 have an average length of stay of 3.4 days, while the average for patients aged 75 and over is 8.6 days.
    
Knowing what our patients’ wishes are when it comes to receiving care is very important, and we hope that, through evaluating the new models of care, we can evidence a new model that suits both patients and care providers.

How are the new models of care making a difference?
Dr Tom Knight, from Sandwell and West Birmingham NHS Trust, is involved in the Epicentre project, which focuses on Emergency Admission Avoidance Through Point of Care Testing.
    
The Epicentre model is based on acute medical registrars working in the community; patients are essentially admitted to hospital but in their own home, and are still allocated a consultant, just as they would in hospital. There are no specifications on age or frailty, and the project takes referrals from GPs, ambulance services and hospitals.
    
Recently, Tom used the Epicentre model to allow an elderly patient to receive treatment and end-of-life care in his own home. The 81-year-old male was referred to the service through his GP and the ambulance service with symptoms of coffee ground vomiting, several months of progressive dysphagia and significant weight loss. With a previous history of a duodenal ulcer, there were suspicions that the patient had a UGI bleed, but on further inspection, it was found that he had a gastric outlet obstruction.
    
Tom could deduce that the problem was not treatable, and the patient made it clear that he would not go into hospital, so he was transitioned onto a supportive care plan. Conversations were able to be had with the patient and his family about his wishes and where he wanted to be, and a plan was enacted to manage his symptoms and keep him at home.
    
As a result, the patient was cared for at home until the end of his life, meeting his wishes and relieving pressures on the hospital that he would have otherwise been admitted to.

What do we hope to achieve?
Since the NIPP started in early 2022, we have seen some initial findings which indicate success. In one month, 102 conveyances were avoided at 50 per cent call rate, and 450 patients over the age of 75 were conveyed to South Warwickshire Foundation Trust instead of 552.
    
We hope this success will continue, and the primary findings will be available in spring 2023, followed by the ARC West Midlands evaluation and subsequent implementation guides.
    
Our ambition is to continue alleviating the extreme pressures that the NHS is under, especially at this time of year, and ensuring that patient safety and comfort are continuously prioritised and improved.