NHS Calderdale Clinical Commissioning Group: The Quest for Quality in Care Homes

Abstract

NHS Calderdale CCG established the Quest for Quality in Care Homes in anticipation of increasing demands on resources due to an ageing population and corresponding increase in long-term conditions. It aimed to introduce a more consistent and sustainable model of care for older people living in residential care in Calderdale, taking a person-centred approach and helping to make efficient use of health and social care resources. The Quest programme combined a Multi-Disciplinary Team (MDT), real-time access to live clinical records, and telecare and telehealth systems in order to: Reduce avoidable ambulance call outs, A&E attendance, hospital admissions and GP visits Improve resident care and safety Respond more effectively to urinary tract infections, respiratory infections, falls and fractures Support staff to feel confident in providing high quality care Improve quality of life for residents The MDT includes dedicated Quest Matrons; Consultant Geriatrician; Pharmacist; Clinical Psychologist; links to Palliative Care and to other areas such as tissue viability. It works with key stakeholders including residents, care homes, Calderdale Council and primary care staff to minimise the need for residents to access unplanned care services and ensure patients are proactively managed to keep them within the care home setting. The team also works with secondary care staff in hospitals to support the timely discharge of residents. More than 1300 residents have been supported in 38 homes as part of the Quest for Quality over the last five years, and the project has achieved significant financial efficiencies: Year-on-year results: 2014/15: Hospital stays reduced 26%; Hospital bed days used reduced 16%; Emergency admissions reduced 25%; GP visits 58% fewer than non Quest Homes; cost of hospital stays reduced by £456,166. 2015/16: Hospital stays reduced 26%; Hospital bed days used reduced 30%; Emergency admissions reduced 33%; GP visits 45% fewer than non Quest Homes; cost of hospital stays reduced by £799,561. The latest phase of the programme evaluated the impact of using technology to manage the risk of falls and mitigate their consequences. Comparing 2016/17 to 2017/18: Emergency admissions relating to falls have decreased by 7.7% resulting in an annual saving to the Quest programme of over £200,000 50% of care homes saw a reduction in falls of at least 10% Falls related incidents as a percentage of total incidents decreased from 25.7% to 23.7% year-on-year The Quest for Quality in Care Homes demonstrates the benefits of integrated working between health and social care, and how technology can support this by: Enabling services to be integrated and delivered at scale by sharing timely, relevant information across multiple stakeholders Empowering care staff to take a preventative approach, using real-time information to identify issues at an early stage, and mitigates consequences of emergency events by enabling prompt responses Enabling the proactive management of residents by reviewing trends over time Facilitating effective communication between all levels of care The project has created a new model for care delivery which is replicable, scalable and addresses the challenge of care home residents being disproportionate users of health services.

Keywords

• technology
• integrated
• efficiency
• sustainability
• healthcare