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Assertive OutreachService
Health, Wellbeing and Social Care Scrutiny
27th October 2010
Overview
• Why
• What
• What if
In 2008-09 alcohol related bed days equated to
approximately 40,000 bed days OR 111 beds
63% emergency admissions
Repeat A & E Admissions (2005-2008)Courtesy of Mark Knight and Gordon Adams -Salford DAAT
% of Total Attributable Factor of All 15,272 Individuals (2005-08) A&E Only
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0 2500 5000 7500 10000 12500 15000
Number of Individuals
% o
f T
ota
l A
ttri
bu
tab
le F
ac
tors
10,000 people = 92.3%
100 people = 13.1%
Virtual ‘Outreach’ Team
• A&E Consultant
• Acute physician/ gastroenterologist
• Alcohol specialist nurse
• Community alcohol service manager
• Mental Health – Crisis response team
• GP Homeless Service
• Age Concern
• Salford DAAT
What does a virtual team mean?• From mid June to December the team met fortnightly for 2-2.5
hours to assess the Top 20 patients and agree action plans• Hours input-
– Alcohol specialist nurses 82 hrs– Community Alcohol Team Manager 46 hrs– A&E consultant 30 hrs– Gastroenterologist 30 hrs– Crisis Response Team( Mental; Health) 10 hrs– GP Homeless Practice 8 hrs– Age Concern 6 hrs
– Plus a 7 hours spent visit alcohol services across Salford followed by a debrief
Total of 250 clinical hours approx
All age all cause mortality
Top 100 2007-08 - 24 had died
Age No. deaths
%
20s 1 4.2
30s 1 4.2
40s 3 12.5
50s 10 41.7
60s 6 25
70s 2 2.1
80s 1 1
Top 20 cohort 2007-08 Patient
Medical
Alcohol team contact
Mental Health
Forensic interest
Social / Housing
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Key Problem Currently abstinent/ no longer able to drink/ not alcohol related
Top 20 – problem list identified thru’ MDT assessment review
Top 20 – common presentation
• Multiple referral to ASN team- BI given
• Multiple referral to community alcohol service – no/ limited engagement
• Previous detoxes
• In and out of prison
• Difficult home situation/ abuse (multidirectional)
• Bereavement issues
Assertive case management
• Visit at home
• Linking with other services
• Smoothing pathways
• Management plan ready to go on next admission
• Prioritise/ fast track
• Bridge service gaps
• Support with additional services/ activities
‘Top18’ patients…..snapshot Oct 2009
• 11% unfortunately died
• 15 of the 18 aged <51years
• Third <40 years
• 271 A&E visits
• 148 admissions
• 1.81 beds ( 100% occupancy)
• HRG tariff costs of £257,430
• Expensive not only to health
Early results
Number of A&E attendances and admissions pre and during pilot
Outcome- all patients except non-alcohol and RAG = grey
% Reduction A&E attendances16.5 (n=125)
% Reduction in admissions from A&E
14.3 (n=49)
Conclusions ( April 2010)
• Big problem with a financial & societal cost to match
• Current services have gaps
• AOT plugs gaps with some early suggestions of benefit
• Worthy of further investigation
AOT Phase 2
• May 2010- completed Frequent Flyer proposal/ business case as part of Integrated Partnership Board
• Business case suggested alcohol, drug misuse
and self harm presentations were strongly interlinked
• AOT business case extended to include drug misuse, self harm & alcohol
AOT Phase 3
• June- August 2010- Completed further analysis which strengthened extended business case
AOT Phase 4
•Potential pilot in Salford initiated by Drinkwise Northwest – Intelligence led alcohol harm reduction working with ‘Better Life Chances’
AOT remit - if/when funded
• Top 30 patients admitted in relation to alcohol, drug misuse and self harm
• Up and comers( 2ARAs)- – 8 from 72 now in top 30– Top 30 ranked positions of 1,2,4,20,21&26
• Strengthen relationships with other statutory services and third sector organisations (including Narrowgate Shelter/ Windsor Drop In)
Proposed Outreach Team
• Consultant emergency medicine• Gastroenterologist/ liver disease• Psychiatrist• CPN ( alcohol background)• Social worker AMP (Mental health practitioner)• Clinical psychologist • Tenancy support work• Health trainer/ star worker• Police / probation officer• Alcohol specialist nurse• Admin support
Recommendations
• Support commissioning of the AOT
• Need for all statutory services to work in more than partnership
Thank you !!!!