How integration can prevent hospital admissions and support higher quality care

We hear from Chloe Wynn, Registered Manager at Belong Morris Feinmann, on how she believes integration and collaboration between health and social care can prevent hospital admissions and result in a higher standard of care for those being supported.

Anyone working in older people’s care is all too aware of just how traumatic a visit to emergency departments can be for vulnerable older people, so it was with a view to exploring what we could do to improve this patient experience that I recently contacted Wythenshawe Hospital Emergency Department. I was impressed by their receptiveness to open a dialogue around this and was invited by Dr Fiona Topham, one of the consultants in their Emergency Department, to spend the day observing patient experiences and discussing opportunities for increased integration and better collaboration.

While there I followed the journey of a 92-year-old person with dementia, as they travelled through the department over the course of 15 hours to receive treatment. It likely comes as no surprise that the experience was an unsettling one for that person, as they arrived at the hospital unaccompanied and unable to communicate their problem clearly.

For people with conditions, such as dementia, a hospital visit can be an extremely stressful and disorientating experience, one that can produce negative health outcomes itself. I firmly believe that with better, more integrated, more collaborative care in place, we can minimise the need for people accessing adult social care to endure these experiences and reduce hospital admissions.

At Belong Morris Feinmann, we’ve witnessed first-hand the difference that a more collaborative, integrated care approach can make to our residents. Health and social care integration is essential for providing person-centred care that enables the supported person to feel comfortable, in control and living their chosen life.

One of our most notable integration success stories is our relationship with our local GP practice, Barlow Medical Centre. We used to spend hours ringing around surgeries, trying to secure appointments for people we support. By tapping into the Government Care Home DES [Direct Enhanced Service] funding, Barlow Medical Centre were able to allocate a rotation of three consistent doctors who between them attend site each Tuesday, working with our team, providing a consistent medical service to residents and making informed decisions on their care, including holding multi-disciplinary team meetings where needed. This facilitates advanced care planning, allows for regular check-ups and most importantly, keeps people within their familiar care setting throughout. After this initiative began, we saw an approximate 50% reduction in hospital visits for those we support.

Another notable way in which we can improve outcomes from a preventative perspective is by managing the amount of time that those we support spend in unfamiliar healthcare settings. By doing this, we’re lessening the severity of the often-distressing experience, which in itself can be a step towards preventing further health decline. We find that those who spend more time in hospital are more likely to return to hospital or become ‘lost in the system’, unable to be successfully discharged.

One method we’re currently investigating to improve in this regard is through a partnership with our local emergency department, looking at ways in which we may be able to pre-book initial A&E assessments for less urgent medical problems. In some scenarios, we believe that this would mean health outcomes would likely be better for the supported person. For example, a person with a suspected broken finger may find it better to remain in our care until a time at which they can receive a pre-booked initial assessment within an emergency department, as opposed to spending several hours waiting in an emergency department queue.

Although this project is still in its infancy, we’re hopeful we can establish a process whereby we can secure our residents an initial assessment slot via the phone, avoiding the often-stressful emergency department experience. I believe this will be a brilliant step towards not just improving this experience but minimising a further decline in the condition of people living with some conditions.

Another crucial way in which preventative measures can be improved is through expansion of existing collaborative services. At Belong, we’re lucky to have regular visits from teams that work in the community, such as our local intravenous (IV) therapy service, which enables our residents to get some of their treatment in their familiar care setting, as opposed to travelling to a medical setting. These measures are amazing, and I’m keen to see these initiatives expand in terms of the range of treatments they can offer, perhaps to include interventions such as IV fluid treatments, which many of our residents still have to travel for. In doing this, we can again work towards keeping our residents in their familiar care settings.

In terms of measuring the effectiveness of these practices, we have to look beyond the most obvious measures, such as the number of hospital admissions from a care setting . One metric we should consider is how many of our residents ended their life in their chosen environment, as opposed to a healthcare setting. In most cases, our residents express the desire to not pass away in a hospital, preferring to end their life in their home. This is a crucial measure for how successful integration has been in preventing hospital admissions. In addition to this, we should keep a close eye on the number of days, or overall time, that our residents spend in hospitals during admissions, aiming to reduce it where possible.

Ultimately, all these approaches to prevention rely on collaboration and communication between health and social care services. By collectively addressing some of the more challenging elements of the health journey for those we support, we’re able to generate new and innovative ways in which our services can integrate to deliver better outcomes for the people we support.

Learn more about our integration campaign: Making integration happen (skillsforcare.org.uk)

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