Technology is transforming patient flow across Lincolnshire Health and Social Care Economy Background
Lincolnshire Community Health Services NHS Team's (LCHS) first goal was to assist in driving a county-wide Acute Admissions Reduction Programme, focused on pro-active care, case management and early intervention to avert crisis and keep patients in the most appropriate care setting. The Programme also responded in part to the significant growth in the number of people over the age of 85 in Lincolnshire. A big challenge for LCHS, which manages one of the largest healthcare communities over an area of 2,350 square miles with a population of over 735,000.
The initial requirement was to make visible the status of patients being managed by the county wide contact centre which coordinates referrals between Independent Living Teams (ILT) covering health (Community Nursing, Physiotherapy, Occupational Therapy etc.,) support (Re-ablement Services) and a Discharge Hub within the local acute hospital.
Jo Cudmore, Business Lead for Winter Management at LCHS said: "Due to the huge geographical area we cover, we wanted to know what capacity we had at each community hospital and in each of our community nursing and therapy teams in real time.
" The Project
Previously, organisational-wide capacity information within LCHS was obtained by contacting individual teams and services. However, constantly fluctuating information quickly became outdated and the process was time consuming and open to error.
At the outset there was a high level scope, with little detail, and a need to get real-time data available in weeks not months. The project needed to be:
- Irrespective of organisational IT systems
- Able to have live information in relation to capacity
- Efficient, effective and auditable communication from Contact Centre to teams
- Ensuring information was transmitted 'securely'
Cambio PFM was chosen as LCHS were aware of Cambio's expertise in patient flow from the work done within secondary care and saw within the organisation an attitude to work in partnership with the right culture to meet their requirement for flexibility, agility and speed.
Cambio adopted its standard implementation methodology, mixing workshops with key staff members and rapid prototyping, to deliver the first phase live running solution within four weeks, supporting the proactive management of patients across health and social care.
Real-time views were quickly developed of patient data that were structured by teams and location to support:
- Caseload management
- Bed capacity
- Planned availability
- Planned acute discharges
- RAG boards were also provided to give an at-a-glance overview of multi-agency capacity across the entire geography.
After a short period of production usage, further changes were applied and the solution adopted across all the teams involved.
Reflecting on the deployment, Jo Cudmore added: "In our eyes, working with Cambio was a true partnership. They took the time, albeit under tight timescales, to meet with key users to understand everything we were trying to achieve.
Subsequently the project has been expanded to support:
- A discharge hub giving community services visibility to pro-actively in-reach and plan ahead for managing discharges from the acute setting
- Neighbourhood Teams to better manage activities in the community targeted at admission avoidance and quicker discharge from the surrounding acute providers
- A single view of Assessment Placements across the county enabling proactive management of step down from an acute setting while assessing the most appropriate next stage of care.
With Neighbourhood teams, discharge hub and Assessment Placements now deployed, the innovation continues supported by Cambio technology that adapts and changes as new ways of working are developed and adopted.
What has made the project transformational in Lincolnshire is how it has been implemented and developed across organisational boundaries. This includes LCHS, United Lincolnshire Hospitals NHS Trust (ULHT), Lincolnshire Partnership NHS Foundation Trust, Lincolnshire County Council and GPs sitting in Neighbourhood Teams (multi-disciplinary, multi-organisational teams). Benefits Realisation
Jo Cudmore continued: "This has led to more efficient communication for us, the technology lets us track our patients in real time, so our teams can communicate electronically, making the process much quicker."
- Teams spend more time on clinical activity and work more effectively with colleagues in other organisations
- Fewer unnecessary hospital stays
- Contributing to reduction in length of stay (LOS) at ULHT and in Assessment Placements
- Staff are saving an estimated 20 minutes of calls per patient
- Real-time data that can be accessed and viewed from anywhere on any device providing one version of the truth
- Use of e-whiteboards, PCs and mobile devices that suit the working environment
- Reduction in administrative processes
- Central repository of information for a range of organisations to access
- Visibility of capacity and demand across the system
- Patients experience a smooth and seamless transition of care between services and providers
- Patients are experiencing improved communications and patient safety
The positive impact of the solution on patients has been evidenced by monitoring of the length of stay in the acute following a patient being identified as medically fit for discharge (MFFD). For patients being managed by this process, all of whom were classified as complex discharges, following the introduction of the Cambio solution there has been a reduction in the average length of stay following MFFD from 7 to 4.5 weeks.
During the winter pressure period in the New Year week of 2014/15, 289 hospital admissions were avoided and 337 discharges supported through referral calls taken by LCHS's Contact Centre, which uses the Cayder technology to support its operations.