Dr Angela Wilkinson Consultant Physician February 2020 The H@H - PowerPoint PPT Presentation

Dr Angela Wilkinson Consultant Physician February 2020

The H@H teams Rolled out over 3 localities – commenced April 2012 Glenrothes & North East Kirkcaldy & Levenmouth Dunfermline & West

ICASS (Integrated Community Assessment & Support Service) S P VIRTUAL WARD • A SINGLE Single Point of Access (SPOA)  Geriatrician O  Specialist • Co-located offices Nurse consultant A  GP with • H@H specialist interest • ICT (Intermediate Care Team)  Day Hospital/Day Care • CRT (Community Rehab Team)  Specialist Nurse practitioner  Community rehab team • Community PT  Community mental health team • Day Hospital / Hubs  Home Care Re-ablement  Community Intermediate Care teams • High Health Gain/Complex Care Mx  District Nurse  Home care  Anticipatory care • DPDS (dementia support)  Self care  Tele-care and health  Respite care • Marie Curie  Support for Carers  Voluntary organisations  Social Enterprises  Palliative Care

Each H@H Team  Consultant Geriatrician  Band 7 team lead ( 1 West + 1 East)  CdF or GPST  FY2  Nurses  Band 7 Trainee ANPs x2  Band 6 NPs x6  Band 5 Nurses x3  Band 3 Healthcare Support Workers x4  Admin support  AHPs  Pharmacy input

What can/can’t we do? Can do: CANNOT do:  IV furosemide  RCC transfusion  Scut furosemide  Continuous IVI  IV antibiotics (max TDS dosing)  Vancomycin / QDS IV Abx regimes  Scut fluids / IV fluid ‘bolus’ / combo (max  QDS visits feasible is 2l in 24hr )  Magnesium infusions  Patient obs TDS max  IV Digoxin (needs cardiac monitor)  Blood tests once/day  Accurate urine output monitoring is  IV Pamidronate / zolendronate tricky at home/NH!  Use midlines (can’t insert them)  Syringe drivers / end of life care  Low dose oxygen (2L or use SHOOF)

An expanding service..... End year 2012 2013 2014 2015 2016 2017 2018 2019 TOTAL End 2015 Admissions 232 768 1571 1839 2113 2020 1886 1790 12,219 to H@H / YEAR ~150 patients ‘admitted’ to H@H per month in 2019

H@H - January 2019 40 East Division: Patient's West Division: Patient's 35 Number of Patient's on Caseload 30 25 19 26 26 24 22 21 20 26 18 14 14 25 21 20 19 14 20 13 19 12 16 3 15 0 10 15 15 14 4 14 14 12 12 12 12 12 11 11 11 11 5 10 10 10 8 8 8 8 8 5 0

AVERAGE WEEKLY referral (% per quarter) 65 GP vs S/D 60 55 AVERAGE WEEKLY referrals 50 45 GP % SD % 40 35 30 25 Q1 (2017) to Q2 (2019)

Quarterly Average Length of Stay 12.0 10.6 10.3 10.3 10.0 9.5 9.1 8.0 8.0 7.6 7.2 7.2 7.0 6.8 Days 6.3 6.3 6.2 H@H D&WF 6.0 5.9 5.9 5.7 5.6 5.4 H@H GNEF H@H K&L 4.0 Fife Average 2.0 0.0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 2019 2019 2019 Yearly Quarters

Fife H@H Rate of Re-admissions Per Quarter - Q1 2015 to Q3 2019 25.0% 21.6% 20.0% 17.9% 18.7% 17.2% 16.7% 16.3% 15.7% 16.1% 15.6% 14.8% 15.0% 15.0% Percentage 14.1% 13.6% 13.6% 13.4% 12.3% 10.8% 10.0% 9.0% 8.6% 5.0% 0.0% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 2019 2019 2019 Yearly Quarters

Transfers to acute from H@H 14% 12% 10% 8% Quarterly transfer rate to 6% acute hospital % 4% 2% 0% Q1 2019 Q2 2019 Q3 2019 Q4 2019

My ACP

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