A joint emergency response for those at risk of acute hospital admission in Cambridgeshire

Abstract

Introduction: Cambridgeshire is a challenged health economy with a significant current overspend and consistent suboptimal performance against national targets for A&E waiting times. Community care in Cambridgeshire has undergone enormous change in the last 3 years in an attempt to address these problems. An example of this is the instigation of a county wide joint emergency team JET. Practice change: Previously there were small local schemes aimed at avoiding unnecessary admissions to acute care by providing a community response. Other parts of the county had no such provision. As part of a complete re-provision of community care following system wide consultation, a county wide service was commissioned, the JET team. This team initially comprised 6 experienced nurses or paramedics across the county who responded within four hours to a restricted number of presentations. The service has evolved to include a triage service, nursing, paramedics, therapy, care workers and access to community pharmacy. Medical input is currently provided by primary care but adding dedicated medical time is planned. Aim: The aim of JET is to prevent unnecessary hospital admission for the over 65’s or those with long term conditions by treating them rapidly and holistically at home. Targeted population and stakeholders: There are 165,000 people over the age of 65 in Cambridgeshire. We consulted widely with stakeholders including service users, primary care, commissioners, 111 service, ambulance service, acute trusts and local mental health services. Highlights: The service is in its third year. In the last nine months we received 6207 referrals. 87.9% of those have resulted in the patient being treated at home. We have engaged in repeated audits by independent GP’s to look at what is genuine admission avoidance. The latest audit suggests that 42% of patients seen by JET would have been admitted to acute care without JET. Based on the current local tariff for an acute geriatric admission the costs of admission to acute care would have been £4,431,798. The cost of the JET service over that period was less than £1,500,000. Checks ensure patients are not admitted within 30 days of being seen to be sure admission has been genuinely avoided, not delayed. Patient satisfaction is also high with 90.2% of patients willing to recommend the service to their friends/family. Sustainability: Despite some initial scepticism there is now a consensus that JET provides clinically appropriate care at home. This is popular with patients and is cheaper than admitting to acute hospitals. JET has received extra investment and will expand in size and professional heterogeneity as well as providing increased input to new areas, for example psychiatric wards for dementia and diverted calls from the ambulance service. Conclusion and lessons learned: Emergency response teams for the deteriorating frail elderly are feasible and can occur at scale. They can provide quality care in a preferred setting at lower cost. Essential to success has been whole system engagement, a willingness to adapt and change as the service developed and robust data collection to demonstrate the worth of the service.