Oxygen in Walsall

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Oxygen in Walsall

• Dawn Glynn

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Walsall Background

• Population c. 263,000
• High Incidence of COPD (World Health)
• 1.4
• COPD Register 3822

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Where we were-Pre 2006

• Existing assessment service in CMU
• 100 Patients per year
• Referrals mainly from Secondary Care

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Walsall Infrastructure

• BREATHE
• Clinicians
  
• Commissioners
• Primary Care
• Multi Agency
• Economy Partnership Head start

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What have we got?

• Secondary Care Oxygen Assessment - LDP
• CMU
• COPD Register
• Spirometry LES
• EXPERTISE
• Strong partnership links

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What did we need to do?

• Clinical Consultation process
• Agree Care Pathway
• Pilot
• Patient Satisfaction
• Fine tune Care pathway
• Role out the LES
• Training/Equipment
• Ensure total patient Coverage
• Monitoring and Tracking- Joint data base

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Overall Pathway
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Patient Satisfaction Pilot
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Costs - Local Enhanced Service

• Approx. cost of Oxygen per year 870 per patient
  
• New patients - Hospital assessment - 150-200
• LES - Current Spirometry Service - 10.32
• Spirometry Oxygen - 16.41
• Domiciliary 4.17

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Review of New service (1)

• 2006
• 137 patients referred for assessment
• 36 met LTOT criteria
• 2007
• 165 patients
• 53 met LTOT criteria

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Review of New Service (2)

• Number of patients assessed in Primary care 115
• CMU 56
• Total number 556
• Outstanding 385
• 31 Reviewed
• 69 outstanding

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Review of New Service(3)

• Pilot Practice 36 gt 29 (gt6090)
• 1 x PF/ 2 x Cardiac/ 5 Palliative/ 1 x
  neurological/ 1 Asthma (19 remain)
• 2 x Ambulatory only/ 4 to unstable for
  assessment/ 3 COPD end of Life (10 remain)
• Approx 35
• Arguably 23 should still be seen (79)

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What we learned

• Patients were not being assessed at the desired
  rate
• Reviews governed by patient stability
• Difficulties in setting up joint data base
• Tracking patients essential
• All needs not met
• Review of Pathway required
• Continuous driving necessary
• Pathway review necessary
• Timed audit and performance monitoring

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Future of the service

• Audit reasons for lack of GP buy in address
  Too much work/ not cost effective/ Too
  complicated-Measures
• Review pathway Plug gaps
• Commission outreach services from acute hospital
  - Oxygen nurse
• Data base nhs.net ???????????