Sutton Coldfield Unplanned Admission Avoidance in the Elderly Project

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Case Study Summary
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Overview summary:
The Sutton Coldfield Unplanned Admission Avoidance in the Elderly Project involved six General Practices working together to design and implement a method of improving unplanned care for their patients over the age of 70.

Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.

Approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes.
Challenge identified and actions taken :
Experienced community nurses were employed to undertake urgent assessment and intervention in patients at risk of imminent admission and of all patients soon after discharge to reduce readmissions. A later additional work stream facilitated earlier safe discharge for inpatients, the ‘pull system’, with active monitoring via a live software feed with real-time details of admitted patients. Relationships between hospital and community medical and social teams were formed and strengthened and new pathway models planned and implemented.

Data collection was both subjective and objective.

The subjective data of ‘crisis’ admission avoidance indicated that 75% of interventions had a significant impact on reducing the likelihood of admission for a relatively low number of interventions each month. For post-discharge reviews this level of impact was much lower at 15%, but for a much larger number of contacts. Early safe discharge intervention demonstrated a moderate or more level of impact for at least 60% of up to 230 interventions each month.
Impacts / outcomes:
​Objective results showed a 20.0% reduction in hospital mortality for ACE project patients (p=0.014, ChiSq Test) with no comparable reduction for other local practices not in the project.
There were significant reductions in both average length of stay and cost of admission. A system-wide change in average length of stay and cost was observed but the project practices saw greater reductions compared to the other local practices, and we estimate that we achieved an additional cost saving of £324,000 over 2 years.
Supporting quote for the innovation from key stakeholders:
In conclusion, approaching the project in a structured manner and learning service redesign skills maximised the potential for impact and positive outcomes. The observed reduction in hospital mortality, in particular, points towards a significant improvement in patient safety. Reductions in cost and average length of stay also occurred but, as clinicians, nothing compensates for the significant time and effort involved in changing how our National Health Service functions better than the knowledge that patients are now less likely to be harmed.
Which local or national clinical or policy priorities does this innovation address:
Patient Safety, Unscheduled Care, Primary Care.
Plans for the future:
Share the message and continue delivering and improving the service.
Tips for adoption:
Invest up front in the Improvement Science Foundation training and support before attempting to replicate this elsewhere.
Contact for further information:
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