High Intensity User
ProjectAn innovative initiative, one of the first of its kind in
the country
Boena Zeneli06 December 2018
To ensure that ‘High Intensity Users’ – those who engage with
urgent & emergency services inappropriately, are supported
to access the right care, in the right place at the right time.
To thereby, meet unmet patients needs and improve
patients’ and staff’ experiences and to create capacity and
make financial savings.
Our ambition
The number of ambulances dispatched, A&E attendances and
admissions all decreased on average by 36%
Patient receive the right health care and the clinical as well as
non clinical needs are met
Staff are happier and better supported to make complex decisions
Potential savings of £48,230 were identified for the pilot. For the
expanded project, average savings per patient of £2,613.56,
with a total saving of £122,837.32
Outcome
The pilot began in 2015 with a focus on three patients, and
due to its success, a larger scale project was agreed
This expanded project has resulted
in significant achievements. Over
a period of 12 months, 5 HIUs have
called the Ambulance service 1,196
times between them but our project enabled the Ambulance
Service to only send an ambulance on 199 occasions
Impact and Involvement
By discussing HIUs via our multi-disciplinary team
approach (MDT) in a holistic way, we have improved
integration across the health economy, including: acute,
ambulance, mental health, community, 111 and OOH services
In addition, there is regular collaboration with social care,
voluntary services, the police and the borough councils
Both behavioural changes among HIUs and financial savings
as well as better working environment have led to a more
efficient and effective service for the patients we serve
Impact and Involvement cont…
How we learned and shared
our experience
We consulted for advice with a number of organisations including the
London Ambulance Service and learned from Blackpool CCG model
We have helped Ipswich and East Suffolk and West Suffolk CCGs who
are part of our STP footprint
We have been contacted by Mid Essex CCG, Bromley CCG, West Essex
CCG, Chiltern CCG and Aylesbury CCG who have appreciated our help
We have also published an article on NHSI (Academy of Fabulous Stuff),
presented for EdgeTalks,
We have been contacted by our local Right Care lead and asked to share
our work as an example of best practice nationally
Information governance and data sharing agreements
Being restricted, due to IG, to have all partners in one room
Meaningful and continuous engagement
from providers
Sustainability and taking the ownership
of the move to Business as Usual phase
The challenges so far
What our MDT members say
about the project
“Without collaborative, multi-disciplinary working, we cannot expect to
deliver patient-focused, cost effective services that allow us to maximise
resources where they are needed most…”
East of England Regional Clinical Coordinator Paramedic
“If it stopped, I would not have access to provide better quality care for my
patients. There would be no integration at all between primary and
secondary care and it would be very difficult to support these patients…’’
GP Practice Matron
“We have made a difference to patients who are now not HIUs due to our
regular communication…I do feel that it would negatively impact our
patients if the group were to disband…”
Deputy Clinical Director, East of England Out of Hours Service
The HIU project has proved that it works and that the impact for Patients, staff and the economy as a whole are significant
The susses of this project has been recognised by
the HSJ Awards in the category of ‘Improvement
in Emergency and Urgent Care’ therefore,
considered to be a ‘best practice’ and would serve
other organisations nationally
Currently we are looking at how we make this business as usual, first locally and then across our STP
Looking also at expanding the scoping into children's services
Conclusions and the Future…
HSJ Awards 2018 Finalist
www.greenbrook.nhs.uk
Next steps in transforming urgent and emergency care services6th December 2018
Integrated, primary care led, urgent treatment centres
www.greenbrook.nhs.uk 12
Well-run, integrated, primary care-led UTCs can bring significant benefits for patients and commissioners
50-60% fewer patients in A&E
Significantly improved performance compared to A&E
Better experience for patients
Much lower costs per patient for commissioners
www.greenbrook.nhs.uk 13
1
2 Clinical assessment and navigation of all A&E walk-in patients within 15 mins of arrival
Ability to influence future
patient behaviour – Patient
Champions lead the way
4
3 Special urgent primary care approach allows UTC to keep more acute patients out of ED -only limited use of blood tests
5
Integrated with other local services that can better look after patients
6
Excellent primary care led UTCs share 6 key features
Patients see the clinician that can discharge them home first - rather than at the end of the process
The UTC is the front door to A&E – no other way in
www.greenbrook.nhs.uk 14
PRIMARY CARE-LED UTC & OUT OF
HOURS
Community Pharmacies
Mental Health
Drug and Alcohol Service
Community Services
Social Services
Community Dentistry
Integration and partnership working are crucial for successful urgent care systems
General Practice and GP hubs
Emergency Dept. & Specialities
www.greenbrook.nhs.uk 15
Successful integration and partnership working lead to a virtuous circle in urgent care
Integrated governance leads to safer services
Patients in the right place leads to improved patient flow
Partnership working leads to better use of scarce workforce
Education and signposting over time leads to lower demand