Non Health-care Professional triage: Nursing and …...There are an estimated 10,000 nursing and...
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© ALSG/MTG, 2017 Non Health-care Professional triage: Nursing and Residential October 2017 Stephanie Allmark
Transcript of Non Health-care Professional triage: Nursing and …...There are an estimated 10,000 nursing and...
© ALSG/MTG, 2017
Non Health-care Professional triage: Nursing and Residential
October 2017Stephanie Allmark
© ALSG/MTG, 2017
National picture
18.7 million adults were admitted to hospital in the UK in 2016 – 7.6 million (41%) were aged 65 years or over
The average length of an admission in the UK for a patient 65 years or over = 9.4 days.
Presenter
Presentation Notes
Currently there are nearly 12 million people aged 65 years or over in the UK with 1.6 million of these over 85 years. In the next 17 years these numbers are set to more than double. 18.7 million adults were admitted to hospital in the UK in 2016 – 7.6 million (41%) were aged 65 years or over The average length of an admission in the UK for a patient 65 years or over = 9.4 days.
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National picture
There are an estimated 10,000 nursing and residential homes in the UK
Among people living in care homes, emergency hospital admissions for avoidable conditions increases by 30%.
Presenter
Presentation Notes
There are an estimated 10,000 nursing and residential homes in the UK Among people living in care homes, emergency hospital admissions for avoidable conditions increases by 30%.
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National picture - DementiaThere are an estimated 850,000 people living with dementia in the UK
People with dementia have poorer outcomes in hospital compared with those without;
• They are 5 times more likely to be admitted• They have longer admissions• They are 3 times more likely to die in hospital.
Presenter
Presentation Notes
People with dementia have poorer outcomes in hospital compared with those without; There are an estimated 850,000 people living with dementia in the UK They are 5 times more likely to be admitted They have longer admissions They are 3 times more likely to die in hospital.
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North West
Up to 10% of calls to the North West Ambulance Service are from Care Homes
Approximately 30% of these calls are discharged on scene.
Presenter
Presentation Notes
The North West Ambulance Service receives just over 1 million calls per year – 10% of these calls are from nursing/care homes. Approximately 30% of these calls are discharged on scene with no need for hospital admission – this equates to around 30,000 patients per year where ambulance resources attend unnecessarily, and who could have been assessed and referred to a more appropriate pathway of care without 999 intervention.
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Why collaborate?
‘Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital’.
CQC Chief Executive David Behan
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Presentation Notes
No one service can tackle this issue in isolation. This is a statement from the Chief Executive of the Care Quality Commission, who recognises the need for all services to work together to provide a collaborative approach in reducing the number of patients being admitted to hospitals unnecessarily. ‘Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital’.
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Why collaborate?
• Care Home staff know their clients best • Care Home staff want to care and manage
their residents with acute conditions without the need for A&E when appropriate
• Care Home staff often struggle to access GP services.
Presenter
Presentation Notes
Care Home staff know their clients best Care Home staff want to care and manage their residents with acute conditions without the need for A&E when appropriate Care Home staff often struggle to access GP services. We know that residential and nursing home staff often recognise the correct referral pathway for their patients, but because of local policies and procedures, a call to 999 is their only option. The introduction of the Nursing and Residential Triage tool, empowers care home staff to make informed decisions on the most appropriate pathway for their patients – it does not ask them to make any clinical diagnosis but allows them to go through a check list of presenting symptoms enabling them to determine the most appropriate time/place for further clinical assessment to take place
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Objectives
Designed for use by both clinicians and non-clinicians, the Nursing and Residential Triage tool has been developed to support Care Home staff to make the correct decision when calling for clinical assistance.
Presenter
Presentation Notes
Designed for use by both clinicians and non-clinicians, the Nursing and Residential Triage tool has been developed to support Care Home staff to make the correct decision when calling for clinical assistance. Unlike the full Manchester Triage System which is only licensed for use by registered health care professionals, the Nursing and Residential Triage tool can be used by both qualified and non-qualified staff.
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Objectives
• Reduce the number of unnecessary 999 calls
• To provide a consistent and safe approach to the management of care home residents with illness or injury
• To provide more appropriate access to alternative pathways of care.
Presenter
Presentation Notes
The aims of the Nursing and Residential triage tool are Reduce the number of unnecessary 999 calls To provide a consistent and safe approach to the management of care home residents with illness or injury To provide more appropriate access to alternative pathways of care. This ensures that patients are not admitted to the emergency department/hospital unnecessarily by using the tool to direct the staff to the most appropriate referral pathway first time.
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Nursing and Residential Triage Tool
• The triage tool has two sides - Injury and Illness
• The discriminators are followed from top to bottom and stop where the patient has any of the symptoms presented on the chart.
Presenter
Presentation Notes
The triage tool has two sides - Injury and Illness The discriminators are followed from top to bottom and stop where the patient has any of the symptoms presented on the chart and it follows the same reductive method as used in all MTS iterations
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Nursing and Residential Triage Tool
Presenter
Presentation Notes
This is what the Nursing and Residential triage tool looks like – we’ll have a look at each of the priorities for the tool…
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End of Life or Community Care Pathways
Should the patient have an End of Life or Community Care Pathway in place, these should be consulted prior to calling 999 even in the presence of a red discriminator
Presenter
Presentation Notes
First of all, if the patient is presenting with symptoms documented in any End of Life or Community Care Pathway, this should take precedence over the Triage Tool outcome as long as they are signed and within date.
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Immediate 999 call required
Presenter
Presentation Notes
Depending on the initial presenting complaint, this will guide you as to which side of the triage tool to use – illness or injury. As with the full version of the MTS, we start at the top of and work our way down the discriminators. If the patient is displaying any of the symptoms in this priority, this is where we would stop and follow the advice in the outcome box – in this case it would be an immediate call to 999. If all of the discriminators in this priority can be excluded, we can move down to the next priority….
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Further assessment required
Presenter
Presentation Notes
You will notice that although the majority of the discriminators are transferred from the full Manchester Triage System, a small number of the discriminators and their definitions, were amended following feedback from staff in the trials to make the meaning of them easier for non medical staff. New discriminators were also introduced such as ‘dizziness prior to a fall’ and ‘worrying wound’ to try to capture all patients that may need further assessment.
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No Discriminators Found
If no discriminators are found, the patient’s own Primary Care Team may be contacted.
Presenter
Presentation Notes
On assessing a patient, if they do not have any of the discriminators in either the red or the yellow box, then it may be appropriate to refer them direct to their GP, District Nurse or Out of Hours Service. If there is any concern then 999 should still be called for, regardless of the triage outcome If the patient has fallen and no discriminators are present, the patient can be assisted from the floor using correct lifting aids/manual handling techniques or a local falls/lifting service could be contacted for assistance if available
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Evaluation
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Feasibility Study
Two care homes were selected as they were high users of 999;
• Care home 1 - A care home with no registered nursing staff
• Care home 2 - A nurse-led home.
Presenter
Presentation Notes
A study was carried out with the north west ambulance service to look at the safety and efficacy of the nursing and residential home triage tool. These homes were picked for the initial trial as they were high users of 999 but also so dthe results could be compared between the staff using the tool – as one was nurse lead and the other had no registered nurses on site.
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Feasibility Study
During the 3 months that both homes trialled the Nursing and Residential Triage, they saw a marked reduction in
999 Activity
There was no increase in the number of HCP admissions from these homes
There were no critical or adverse incidents reported during the 3 month feasibility study.
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Care home 1 • Trialled from November 2016 to January 2017
• Decrease in 999 calls and hospital admissions
Presenter
Presentation Notes
This chart shows the hospital admissions, the number of patients discharged on scene following ambulance assessment and the number of health care professional admissions for the first care home – not nurse led – in the trial. The period where the tool was introduced is highlighted in blue There was a marked decrease not only in the number of 999 calls and hospital admissions with the introduction of the tool, but also in the number of calls where an ambulance was requested and the patient was treated on scene – this suggests that with the introduction of the tool, calls being made to the ambulance service were more appropriate.
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Care home 2
• Trialled from November 2016 to February 2017
• Decrease in 999 calls and hospital admissions
Presenter
Presentation Notes
The same trends were seen in the nurse led home as the home without Health Care Professionals – a decrease in 999 calls, hospital admissions and where 999 calls were made, these generally resulted in the patient being transferred to hospital.
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Pre and Post Nursing and Residential Triage tool figures
Care home type
6 months prior to implementation
6 months post implementation
Average calls per month
999 conveyance
rate
Average calls per month
999 conveyance
rate
Call reduction
Residential home
7.33 52% 2.6 87% 64%
Nursing home
15.83 59% 7.6 87% 52%
Presenter
Presentation Notes
In the first care home before the trial they were caslling 999 on average 7.33 times per month and had a conveyance rate ot only 52%. Following the trail the average number of calls reduced by 64% to only 2.6 times per month. In the second care home there are similar results with 15.83 calls per month prior to the tool compared to 7.6 callser per month after. Both homes saw their conveyance increase to 87% You can see the reduction in the calls from each of the care homes – and although these are not massive in terms of numbers per month, applied across the whole of the North West, this would be a significant reduction in calls to the ambulance service. It also shows that where calls to 999 are made, they are appropriate calls as the conveyance rate has increased for both homes.
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Potential cost savings for 2 care homes
Cost savings over 3 months
Projected costsavings over 12 months
999 attendance and conveyance to Emergency Department (£185 per See and Convey)
£9158 £36,630
Emergency Department attendanceonly* (£142.68 per ED attendance) £7063 £28, 251
Total cost savings £16,220 £64,881* Does not include Hospital admissions
Presenter
Presentation Notes
These figures show the potential
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Next Steps in NWAS
6 month pilot across the North West to look at;
• Comparison of 999 calls - 6 month before and 6 months after
• Staff survey • Audit use of the tool• Cost savings• Ambulance hours prevented.
Presenter
Presentation Notes
We are currently undergoing a roll which includes over 200 care homes across the North West, the data from which is being evaluated at the moment but appears to be similar to the data from the first 2 homes.
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Future
Buy in from local services such as Urgent Care Desks, local Primary Care Services will be required to enable the introduction of the Nursing and Residential Triage tool.
Presenter
Presentation Notes
Buy in from local services such as Urgent Care Desks, local Primary Care Service will be required to allow the introduction of the Nursing and Residential Triage tool.
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Future
Care homes are introducing the tools with the support of local commissioners
Implementation package now available with e-learning, training and audit mechanisms.
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References
• Nursing and Residential Triage Evaluation, M. Wenman, North West Ambulance Service, 2017
• Older People’s Care in Acute Settings: Benchmarking Report, NHS Benchmarking Network, March 2016
• Later Life in the United Kingdom, Age UK, August 2017
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Non Health-care Professional triage: Nursing and ResidentialOctober 2017
