18.7 million adults were admitted to hospital in the UK in 2016 – 7.6 million (41%) were aged 65 years or over
The average length of an admission in the UK for a patient 65 years or over = 9.4 days.
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Currently there are nearly 12 million people aged 65 years or over in the UK with 1.6 million of these over 85 years. In the next 17 years these numbers are set to more than double. 18.7 million adults were admitted to hospital in the UK in 2016 – 7.6 million (41%) were aged 65 years or over The average length of an admission in the UK for a patient 65 years or over = 9.4 days.
There are an estimated 10,000 nursing and residential homes in the UK
Among people living in care homes, emergency hospital admissions for avoidable conditions increases by 30%.
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There are an estimated 10,000 nursing and residential homes in the UK Among people living in care homes, emergency hospital admissions for avoidable conditions increases by 30%.
National picture - DementiaThere are an estimated 850,000 people living with dementia in the UK
People with dementia have poorer outcomes in hospital compared with those without;
• They are 5 times more likely to be admitted• They have longer admissions• They are 3 times more likely to die in hospital.
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People with dementia have poorer outcomes in hospital compared with those without; There are an estimated 850,000 people living with dementia in the UK They are 5 times more likely to be admitted They have longer admissions They are 3 times more likely to die in hospital.
Up to 10% of calls to the North West Ambulance Service are from Care Homes
Approximately 30% of these calls are discharged on scene.
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The North West Ambulance Service receives just over 1 million calls per year – 10% of these calls are from nursing/care homes. Approximately 30% of these calls are discharged on scene with no need for hospital admission – this equates to around 30,000 patients per year where ambulance resources attend unnecessarily, and who could have been assessed and referred to a more appropriate pathway of care without 999 intervention.
‘Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital’.
CQC Chief Executive David Behan
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No one service can tackle this issue in isolation. This is a statement from the Chief Executive of the Care Quality Commission, who recognises the need for all services to work together to provide a collaborative approach in reducing the number of patients being admitted to hospitals unnecessarily. ‘Those responsible for care in local areas need to work together quickly to address the number of avoidable emergency admissions to hospital’.
• Care Home staff know their clients best • Care Home staff want to care and manage
their residents with acute conditions without the need for A&E when appropriate
• Care Home staff often struggle to access GP services.
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Care Home staff know their clients best Care Home staff want to care and manage their residents with acute conditions without the need for A&E when appropriate Care Home staff often struggle to access GP services. We know that residential and nursing home staff often recognise the correct referral pathway for their patients, but because of local policies and procedures, a call to 999 is their only option. The introduction of the Nursing and Residential Triage tool, empowers care home staff to make informed decisions on the most appropriate pathway for their patients – it does not ask them to make any clinical diagnosis but allows them to go through a check list of presenting symptoms enabling them to determine the most appropriate time/place for further clinical assessment to take place
Designed for use by both clinicians and non-clinicians, the Nursing and Residential Triage tool has been developed to support Care Home staff to make the correct decision when calling for clinical assistance.
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Designed for use by both clinicians and non-clinicians, the Nursing and Residential Triage tool has been developed to support Care Home staff to make the correct decision when calling for clinical assistance. Unlike the full Manchester Triage System which is only licensed for use by registered health care professionals, the Nursing and Residential Triage tool can be used by both qualified and non-qualified staff.
• To provide a consistent and safe approach to the management of care home residents with illness or injury
• To provide more appropriate access to alternative pathways of care.
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The aims of the Nursing and Residential triage tool are Reduce the number of unnecessary 999 calls To provide a consistent and safe approach to the management of care home residents with illness or injury To provide more appropriate access to alternative pathways of care. This ensures that patients are not admitted to the emergency department/hospital unnecessarily by using the tool to direct the staff to the most appropriate referral pathway first time.
• The triage tool has two sides - Injury and Illness
• The discriminators are followed from top to bottom and stop where the patient has any of the symptoms presented on the chart.
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The triage tool has two sides - Injury and Illness The discriminators are followed from top to bottom and stop where the patient has any of the symptoms presented on the chart and it follows the same reductive method as used in all MTS iterations
Should the patient have an End of Life or Community Care Pathway in place, these should be consulted prior to calling 999 even in the presence of a red discriminator
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First of all, if the patient is presenting with symptoms documented in any End of Life or Community Care Pathway, this should take precedence over the Triage Tool outcome as long as they are signed and within date.
Depending on the initial presenting complaint, this will guide you as to which side of the triage tool to use – illness or injury. As with the full version of the MTS, we start at the top of and work our way down the discriminators. If the patient is displaying any of the symptoms in this priority, this is where we would stop and follow the advice in the outcome box – in this case it would be an immediate call to 999. If all of the discriminators in this priority can be excluded, we can move down to the next priority….
You will notice that although the majority of the discriminators are transferred from the full Manchester Triage System, a small number of the discriminators and their definitions, were amended following feedback from staff in the trials to make the meaning of them easier for non medical staff. New discriminators were also introduced such as ‘dizziness prior to a fall’ and ‘worrying wound’ to try to capture all patients that may need further assessment.
If no discriminators are found, the patient’s own Primary Care Team may be contacted.
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On assessing a patient, if they do not have any of the discriminators in either the red or the yellow box, then it may be appropriate to refer them direct to their GP, District Nurse or Out of Hours Service. If there is any concern then 999 should still be called for, regardless of the triage outcome If the patient has fallen and no discriminators are present, the patient can be assisted from the floor using correct lifting aids/manual handling techniques or a local falls/lifting service could be contacted for assistance if available
Two care homes were selected as they were high users of 999;
• Care home 1 - A care home with no registered nursing staff
• Care home 2 - A nurse-led home.
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A study was carried out with the north west ambulance service to look at the safety and efficacy of the nursing and residential home triage tool. These homes were picked for the initial trial as they were high users of 999 but also so dthe results could be compared between the staff using the tool – as one was nurse lead and the other had no registered nurses on site.
Care home 1 • Trialled from November 2016 to January 2017
• Decrease in 999 calls and hospital admissions
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This chart shows the hospital admissions, the number of patients discharged on scene following ambulance assessment and the number of health care professional admissions for the first care home – not nurse led – in the trial. The period where the tool was introduced is highlighted in blue There was a marked decrease not only in the number of 999 calls and hospital admissions with the introduction of the tool, but also in the number of calls where an ambulance was requested and the patient was treated on scene – this suggests that with the introduction of the tool, calls being made to the ambulance service were more appropriate.
The same trends were seen in the nurse led home as the home without Health Care Professionals – a decrease in 999 calls, hospital admissions and where 999 calls were made, these generally resulted in the patient being transferred to hospital.
Pre and Post Nursing and Residential Triage tool figures
Care home type
6 months prior to implementation
6 months post implementation
Average calls per month
999 conveyance
rate
Average calls per month
999 conveyance
rate
Call reduction
Residential home
7.33 52% 2.6 87% 64%
Nursing home
15.83 59% 7.6 87% 52%
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In the first care home before the trial they were caslling 999 on average 7.33 times per month and had a conveyance rate ot only 52%. Following the trail the average number of calls reduced by 64% to only 2.6 times per month. In the second care home there are similar results with 15.83 calls per month prior to the tool compared to 7.6 callser per month after. Both homes saw their conveyance increase to 87% You can see the reduction in the calls from each of the care homes – and although these are not massive in terms of numbers per month, applied across the whole of the North West, this would be a significant reduction in calls to the ambulance service. It also shows that where calls to 999 are made, they are appropriate calls as the conveyance rate has increased for both homes.
• Comparison of 999 calls - 6 month before and 6 months after
• Staff survey • Audit use of the tool• Cost savings• Ambulance hours prevented.
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We are currently undergoing a roll which includes over 200 care homes across the North West, the data from which is being evaluated at the moment but appears to be similar to the data from the first 2 homes.
Buy in from local services such as Urgent Care Desks, local Primary Care Services will be required to enable the introduction of the Nursing and Residential Triage tool.
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Presentation Notes
Buy in from local services such as Urgent Care Desks, local Primary Care Service will be required to allow the introduction of the Nursing and Residential Triage tool.