Quest for Quality: reducing GP care home visits

Time is a chronically depleted resource in general practice and we are constantly on the lookout for innovative initiatives that are improving care while driving efficiencies. NHS Calderdale Clinical Commissioning Group (CCG) has pioneered a clinically-led approach to improving the health of care home residents which has, so far, cut emergency admissions of care home residents by 33% and reduced GP care home visits by 45%.

We caught up with Dr Steven Cleasby, clinical chair of NHS Calderdale Clinical Commissioning Group, to learn more about the ‘Quest for Quality in Care Homes’ initiative and how telecare is helping in supporting care.

NHS Calderdale Clinical CCG – in partnership with Calderdale Council and Calderdale and Huddersfield NHS Foundation Trust – has pioneered a telecare-supported programme to improve the health of care home residents in Calderdale, Yorkshire. The ‘Quest for Quality in Care Homes’ initiative involved 1,300 care home residents over five years, with a multi-disciplinary team (MDT) – the Quest team – and care home staff working to improve care and prevent avoidable emergency attendances and admissions.

Since 2013 the care home teams involved have used Tunstall Healthcare technology to support individual care plans for residents, enabling the prevention of incidents. In the launch phase – 2014 to 2016 – following the introduction of the Quest multi-disciplinary team, NHS Calderdale CCG:

  • cut emergency admissions of care home residents by 33%;
  • made savings equating to approximately 7,000 hospital bed days;
  • reduced GP care home visits by 45%.

The Quest team players

So, how does the Quest MDT work with GPs to reduce the amount of care home visits? “The MDT supports the work of GPs in care homes but mainly offers clinical support to ensure the needs of residents are met – for example, advising on ways to prevent falls and incidents that could affect residents’ health,” Dr Cleasby explains.

The MDT is made up of dedicated Quest matrons, a Quest nurse, a Quest healthcare assistant, consultant geriatrician, pharmacist and mental health practitioner, and has links to other areas such as the district nursing and community matron teams and palliative care. “The MDT works with the key stakeholders including care homes, Calderdale Council and primary and community care staff to minimise the need for residents to access planned and unplanned care services and ensure that patients are proactively managed to keep them within the care home setting,” Dr Cleasby says; the focus is on preventative care that is sustainable and connected.

The team also works with secondary care staff to support the early discharge, where appropriate, of care home residents who have attended A&E and/or been admitted to hospital.

The role of telecare

To date, more than 1,300 residents have been supported through the Quest for Quality programme using technology, including bed occupancy sensors, fall detectors and movement detectors; the technology is in operation 24/7 and alerts staff when residents leave their beds during the night, for example.

“In Calderdale we have found that using telecare in care homes gives users continuous, discreet support and enables carers to respond quickly to any incidents or alerts, which can prevent incidents,” Dr Cleasby tells us.

Reducing GP care home visits by 45%

While GPs don’t directly work with the technology on the project, they work with the Quest MDT and the care homes and, ultimately, benefit from the project and technology. The Quest programme has meant GP call outs to care homes have been significantly reduced – by an impressive 45%; this is because the Quest MDT works directly with the care homes and, given the additional support and quick response to incidents and incident prevention, they call for a GP less often.

“Additionally, the technology underpins this work and is an enabler, which has resulted in a reduction in emergency admissions relating to falls,” Dr Cleasby says, adding that, “Telehealth helps to identify symptoms at an early stage, enabling early intervention and the identification of the need for more complex care. At the same time, telecare helps to prevent falls and enables an early response should they occur, mitigating their effects and reducing the need for GP visits.”

Gauging the impact on workload, quality of care and cost savings

NHS Calderdale CCG’s commissioning plan for 2012/13 included a clear objective to establish a more consistent and sustainable model of care for older and vulnerable individuals in Calderdale. “The aim was to take a person-centred approach to meeting the needs of people with long-term health and care needs and help to make efficient use of NHS resources,” Dr Cleasby explains. A key focus was to reduce hospital admissions from care homes, increasing quality of life for residents and reducing demand on primary and secondary care.

This led to the development of the Quest for Quality in Care Homes pilot, which combined a MDT, real-time access to live clinical records for GPs and Quest for Quality in Care Homes matrons, and telecare and telehealth systems to improve the quality of care and help to reduce avoidable hospital and GP visits. It aimed to:

  • Reduce avoidable ambulance call outs, A&E attendance, hospital admissions and GP visits
  • Improve resident/patient care and safety
  • Respond more effectively to urinary tract infections, respiratory infections, falls and fractures
  • Support staff to feel confident in providing high quality care
  • Improve quality of life for residents

More than 1,300 residents have been supported in 38 homes as part of the Quest for Quality over the last five years, and the project has achieved significant financial efficiencies and associated cost savings since it was introduced. The latest phase of the programme evaluated the impact of using technology to manage the risk of falls and mitigate their consequences for care home residents.

Results 2014/15 Results 2015/16
Hospital stays 26% reduction year-on-year 26% reduction year-on-year
Hospital bed days used 16% reduction year-on-year 30% reduction year-on-year
Emergency admissions 25% reduction year-on-year 33% reduction year-on-year
GP visits to Quest for Quality Care Homes 58% fewer visits than to non-Quest homes 45% fewer visits than to non-Quest homes
Cost of hospital stays Reduced, saving £456,166 year-on-year Reduced, saving £799, 561 year-on-year

Comparing 2016/17 to 2017/18:

  • Emergency admissions relating to falls have decreased by 7.7% resulting in an annual saving to the Quest programme of more than £200,000.
  • 50% of care homes saw a reduction in falls of at least 10%.
  • Fall-related incidents as a percentage of total incidents decreased from 25.7% to 23.7% year-on-year

Calderdale is one of the care home initiatives demonstrating what impact clinically-led technology-enabled models could have on a national scale.

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