Nursing Home Admissions

1
Nursing Home Admissions

• Beginning to Understand and Influence Hospital
  Referrals

2
West Mendip Locality

• Glastonbury Street Wells and surrounding area
• Approx 60,000 population
• 6 GP practices and West Mendip Community Hospital
  
• Approx 350 living in Nursing/ Residential Homes
  (0.6 of Wells patient population, 0.5
  Glastonbury/ Street)

3
West Mendip Locality

• Older population, especially in Wells, ageing
  population generally
• Life expectancy males 81 females 85 (average
  for locality)
• Perception that population in homes becoming more
  complex PEG feeding, IVs in community, better
  palliative care techniques, greater survival but
  with greater disability
• Could some of these be best cared for in-situ
  rather than admitted?

4
West Mendip Health Group

• Newly formed collaborative group of local
  practices
• Nursing Home care identified anecdotally as
  area of pressure and concerns for GPs- including
  potentially inappropriate admissions.
• Perception that OOH/ Emergency service contact
  responsible for potentially inappropriate
  transfers to DGH

5
West Mendip Health Group

• Simple Survey
• Number of patients
• Number of medications
• Number of admissions
• Route of admission
• Number of deaths and where?

6
West Mendip Health Group

• Survey results
• 334 patients
• Average 6.9 separate medications
• 83 patients with in-patient episodes
• 113 total admissions
• 51 via GP practice
• 31 via Unscheduled Care Service
• 18 via 999

7
West Mendip Health Group

• Deaths
• April 08- April 09
• 94 deaths
• 30 in hospital
• 3 in hospice

8
West Mendip Health Group

• Results (cont)
• Only small number of inappropriate admissions
• Majority entirely appropriate and warranted
• Significant minority where alternative to
  admission might have been appropriate

9
West Mendip Health Group

• MORE WORK NEEDED
• Factors affecting decision to admit
• Confidence in and within Care Home especially
  palliative care
• Managing the transition between residential and
  nursing- what to do In the interim
• Workload GP and Home
• ? Driving a reactive rather than proactive
  approach
• ?variable threshold for staff contacting the GP

10
West Mendip Health Group

• Factors affecting decision to admit (continued)
• Advanced care planning recognising the point at
  which management switches from active to
  palliative
• Access to diagnostics

11
West Mendip Health Group

• Economic factors- simple analysis
• One practice 14 patients (30 of all patients)
• with 22 admissions and 7 deaths in hospital
• Average admission 3500 (range 1718- 10,012)
• Total cost approx 78,000
• Personal costs to families
• Access to Hospitals 20 miles to Hospital from
  West Mendip area cost for emergency transfer?
• Bus approx 7 each way
• Taxi approx 60 each way

12
West Mendip Health Group

• Potential solutions
• Non-emergency ambulance calls discussed with GP?
• Greater use of Acute Care GP service for
  diagnostics and/ or facilitation of early
  discharge from AE/ medical teams?
• Ways to smooth transition between res. and
  nursing?

13
West Mendip Health Group

• Potential solutions (continued)
• More pro-active care?
• WMHG want to explore a multidisciplinary
  approach Dr ? Community nurse/matron ?
  Pharmacist ? Social services ? Mental health
• Programme of regular review address advanced
  care planning
• Escalation plans within home shared with
  ambulance, OOH and Primary Link

14
Making it happen

• Other projects being explored elsewhere
• No single model proposed currently need to
  pilot?
• Multi-disciplinary approach has to be the best
  way forward
• Aim would be to eventually fund service through
  reinvestment of savings from avoided admissions