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#Post#: 109--------------------------------------------------
How to reduce emergency admissions through an urgent care centre
?
By: admini5 Date: May 12, 2015, 4:04 am
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Reducing emergency admissions is top of many CCGs’ to-do lists
and Corby CCG has managed to achieve this through its unique new
urgent care centre, says CCG chair Dr Peter Wilczynski
The evidence to date is that urgent care centres (UCCs) remote
from A&E departments do not reduce attendances or admission.
However, the unique nature of the Corby UCC does reduce A&E
attendances and admissions.
This has the potential to be replicated around population
centres of 70,000 or above to support local emergency services
in delivering a high quality A&E service for patients that
require the infrastructure and skills available at a DGH.
History
In 2011/12, NHS Corby was in the bottom 10% of all CCGs for A&E
utilisation. The number of patients being admitted to hospital
for less than 24 hours was increasing year on year, costing
approximately £1.3m annually. The existing community-based
urgent care services were not effective in curtailing A&E demand
or reducing emergency admissions and costs were increasing.
In 2010, as an aspiring CCG, local clinicians developed a vision
for urgent care, which would support clinicians to manage
patients in the community more effectively, streamline services
and improve cost effectiveness.
At the centre of this vision was a community-based urgent care
centre (UCC) with a range of diagnostic facilities and an
observation area.
The business case set out an ambitious plan to build a new UCC
worth £2.6m, decommission all existing community-based urgent
care services and recommission a UCC that would initially open
from 8am – 8pm, 365 days a year with full diagnostic support
during these times.
At the heart of the business case was a £500k annual saving,
achieved through a reduction in A&E attendances and a reduction
in 24 hour admissions to the local acute trust.
Subsequently, an 8am-8pm GP home visiting service was also
commissioned and GP out-of-hours care is also provided during
the opening hours of the UCC to support admissions, avoidance
and enhanced treatment in the community.
Clinical benefits
The key restraint on managing more care in the community is the
lack of access to immediate diagnostics and the ten minutes in
which a local clinician has to make a decision.
The UCC allows the co-location of point-of-care blood testing,
X-ray, ultrasound and observation couches where patients can
remain for four hours.
This changes the ten minute GP consultation to an assessment,
appropriate diagnostics organised by a senior clinician,
observation of response to treatment in the observation couches
and then either discharge, admission to a GP step up bed in the
community or hospital admission.
The service is staffed by experienced local GPs and a
combination of nurses and nurse practitioners. The clinical lead
is also a GP who has an honoree consultant post in a local A&E
department. Staff rotate through the A&E department and the
governance and support for the local diagnostics is provided by
our local hospital.
In essence the UCC can deal with about 70% of activity that now
takes place in A&E departments safely and effectively.
What has been the impact?
The UCC is having a significant impact on the delivery of urgent
care and supporting care in the community as close to home as
possible.
In the first eight months of operation:
[list]
[li]A&E attendances have fallen from 350/1000 population to
171/1000 population, putting Corby into the lowest 10% of CCGs
in the country for A&E attendances (note the A&E figure
including a minor injury unit)[/li]
[li]there has been a 27% reduction in adult 24-hour
admissions[/li]
[li]we have seen a 14% reduction in paediatric 24-hour
admissions[/li]
[li]there has been an estimated full year saving of £685K per
year - about £10 per patient/year. The UCC is contributing to
the QIPP target of the CCG[/li]
[/list]
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[img width=20
height=11]
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[img width=20
height=10]
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Selected ambulance cases are being diverted to the UCC and as
part of a pilot an emergency care paramedic has recently been
stationed at the UCC. This allows ambulances to be back on
station at a fraction of the time taken at our local A&E
department.
All patients have a clinical triage assessment within 15 minutes
of arrival and the UCC has maintained a 100% four-hour target
with most patients being seen and sorted within two hours.
From a personal perspective, the ability to manage patients who
I otherwise would have admitted gives me great satisfaction and
has added another dimension to my work as a GP.
For further information, please follow:
HTML http://www.pulsetoday.co.uk/how-we-reduced-emergency-admissions-through-an-urgent-care-centre/20004077.article#.VVHBLflVhBc
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