Urgent Care Team South Sefton

Urgent CareWho are we?

The team consists of Advanced Nurse practitioners, Allied health professionals and Health Practitioner Assistants.The team are skilled in clinical examination, clinical diagnostics & are non medical prescribers. They have a variety of experience in different fields that makes a well rounded team of acute & community experience

Based at Litherland Town Hall, we provide rapid response (within 2 hours) Urgent Care for the residents of South Sefton under the clinical lead of Community Consultant Geriatrician Dr Asan Akpan  

GP / GP OOH/ Community

Local point of contact

EMIS Web

CommunityGeriatrician Urgent Care Team

Generalist& Specialist Nurses

CareassistantsTherapists

Weekly ‘Hot’ clinic

• 365 days • Active 0800-2100• < 2 hour response• 72 hour care• Integrated with I-care

SOUTH SEFTON URGENT CARE TEAM For sub-acute patients who otherwise would be at risk of requiring acute trust admission

Quality Improvement and Urgent Care

South Sefton CCG, Dr Akpan & the urgent care team started working together in 2014. They recognised that to manage patients with chronic disease, frail, unwell or needing social support or rehabilitation needed a different approach, an integrated MDT approachStarting point: introduced to QI and how it could support organisational change. Our Aim, how could we deliver services in the community avoiding unnecessary admissions Our first initial change was to support a simple referral process, with the support of PDSA cycles we developed a Local Point of contact for referral

 

Example PDSA: PLAN Create a local point of contact for Gp’s and health professionals in 

South Sefton to refer patients to the urgent care team as an alternative to hospital admission 

DO • Introduced a direct referral line to the urgent care team, which enabled trained call handlers to accept referral’s for the team

• Chose one locality to pilot the referral line in (Bootle) and took Gp referral only for this time

STUDY We looked at feedback from Gp’s, number of referrals, time the team was active & response time, and  the affect on workforce & capacity with new referral system, 

ACT The referral line was successful, with little negative impact on the team, and positive impact on GP & patient care. This was implemented and is currently supporting numerous clinical pathways for the Urgent care team 

Example PDSA ‘ramp’:Transfer of MEWS to community

PDSA 2: New form simulation & feedback from nurses > version 02

S DA P

S DA P

S DA P

S DA P

S DA P

PDSA 3: Use-ability n=19 patients > version 03

PDSA 1 : Mews calibration from Acute Trust (n=100 UCT patients) > version 01

PDSA 5: Repeat (4) following changes across variety cases n=80 > Version 05 

PDSA 4: COPD, obs threshsolds, responseto MEWs n=51 patients > version 04

Adapted MEWS assessment incorporated & Implemented

How we overcome challengesWe have a “team huddle” every morning where we discuss 

the challenges from the previous day and how we can overcome them

 Strong Clinical Leadership (from Dr Asan Akpan ) Promote Team Work / Good Communication No blame culture & we learn through the QI tools we use  “Can Do” attitude The patient comes first every time Flexible working Dedicated staff Share good practices and successful outcomes

How do we know our changes make a difference?

Patient Story• Mrs A, 85 year old, lives with her daughter who is her carer. Mrs A has diabetes 

and has become unwell with a urine infection. Mrs A is normally independent, but with the infection has become lethargic, wobbly on her legs and unable to self care whilst her daughter is in work.

•  Mrs A gets frequent urine infections, her diabetes is poorly controlled and she has had 5 admissions so far in the last  6 months 

• Previous to the urgent care team Mrs A would have been admitted again, however her Gp referred her to the urgent care team

• The urgent care team responded within 2 hours, completed a full holistic assessment, examination & in collaboration with the GP developed a care treatment plan for the next 72 hours

• Mrs A remained at home, with her daughter, and continues to be a patient of the urgent care team in times of ill health or crisis. 

Measuring impact: Run charts

What are we planning next?

• A&E community link nurses to facilitate transfer out A&E to community

• Expanding nurse role to include other treatments such e.g. IV abx,

• Point of care diagnostics

• Working more closely with NWAS, out of hours GP

Questions.