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Poster Abstracts

Implementation of a multidisciplinary Enhanced Care Response Service to reduce avoidable hospital admissions among residents of care homes.

Authors:

Maria Loughran ,

Northern Health Social Care Trust Northern Ireland, GB
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Julie Foster,

GB
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Emma McKillop,

GB
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Peter O'Halloran,

GB
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Elizabeth Graham

GB
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Abstract

Introduction: Residents of care homes are at high risk for emergency admission to hospital and many of these admissions may be avoidable. Admission to hospital is associated with stress, loss of independence, exacerbations in chronic conditions, and infection. These risks were compounded by the global spread of COVID 19 early in 2020. In response to these challenges, the Northern Health and Social Care Trust (NHSCT) in Northern Ireland introduced a multidisciplinary Enhanced Care Response Team (ECRT) to work with homes with higher levels of attendance at the emergency department (ED).

Aims and Methods: The ECRT was designed in response to feedback on service needs from residents and their families and in partnership with home managers, community physicians/general practitioners (GPs), allied health professionals, the ambulance service, and acute care providers.

The aim was to reduce avoidable ED attendances of care home residents by 10% over a six-month period.

Led by a senior nurse, the ECRT consists of two nurse specialists in frailty and palliative care, an occupational therapist, physiotherapist, dietician, speech and language therapist, pharmacist, and clinical psychologist. The ECRT receives referrals from care homes or GPs and reaches out to homes with rising hospital admission rates. Residents are assessed by the specialist nurses, who develop an anticipatory care plan (ACP) for nursing care. This informs a weekly case discussion in which residents are triaged by the ECRT, which provides multidisciplinary assessment and intervention. Those most at risk are referred to their GPs for development of a medical ACP. The ECRT also provides tailored education to care home staff aimed at enabling person-centred practice.

Results: The ECRT service was piloted in three care homes from mid-January 2021, with a further six homes added April-May 2021: a total of 484 residents.

In the six months 11/01/2021 – 19/06/2021 there were 152 nursing ACPs completed, 184 residents referred to the ECRT, with 275 profession-specific referrals

Data for six months was available for the three pilot homes. Compared to the same period in 2020, there were 86 fewer ED attendances (73 vs 159), a reduction of 54%; and 60 fewer hospital admissions (33 vs 93), a reduction of 64.5%.Focus groups with care home staff highlighted the benefits of collaborative decision-making, increased confidence among care home staff, and early assessment and intervention, leading to improved outcomes for residents.

Conclusions: This evaluation provides initial evidence that a nurse-led, multidisciplinary, multi-faceted intervention, working in cooperation with care homes and residents’ GPs, can reduce avoidable ED attendances by more than 50% over a six-month period.

Transferability, sustainability, and limitations:

Limitations: although these results are encouraging, they are based on results from three homes, with no control group.

Transferability: the ECRT could be readily applied in health services with similar levels of resource.

Sustainability: the ECRT was supported by funding to meet the challenges of COVID 19. However, reductions in ED attendance and hospital admissions would produce significant cost savings as well as obvious benefits to residents and their families.
How to Cite: Loughran M, Foster J, McKillop E, O'Halloran P, Graham E. Implementation of a multidisciplinary Enhanced Care Response Service to reduce avoidable hospital admissions among residents of care homes.. International Journal of Integrated Care. 2022;22(S3):47. DOI: http://doi.org/10.5334/ijic.ICIC22280
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Published on 04 Nov 2022.

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