Working with the #1 Trust for A&E

When the BBC published the performance of 133 Trusts in October, Luton and Dunstable University Hospital NHS Trust was ranked first for A&E. 98.6% of patients attending A&E at Luton and Dunstable were treated within 4 hours, compared with an average of 90.1% across England. This is an extraordinary achievement.

We’re very pleased to be working with Luton & Dunstable Hospital and Luton and Bedfordshire CCGs on an urgent care project. The project launched in 2015 and initially featured a GP Liaison line for GPs to call if they want to send a patient to hospital that day. The project has since expanded and now includes a Paediatric Advice & Guidance line.

So, what can we learn from Luton & Dunstable’s approach to Advice & Guidance? Luton CCG has kindly given us permission to use the following data:

1. There’s a better place to send patients than A&E

The GP Liaison line is staffed by a rota of nurses. The purpose of the line is primarily to direct the patient to the right service in the hospital for them, rather than sending them to A&E and THEN to the right place. In some cases the nurse is able to offer advice that keeps the patient’s care with the GP or signposts them to community provision.

When a call is made to GP Liaison, the patient’s NHS number is recorded by the Urgent Connect system. The Trust / CCG then tracks where patients are sent within the Trust after the call. The chart below is their data and shows where patients end up.

To put those outcomes in percentage terms:

  • Unknown (out of hospital): 7.5%
  • A & E: 24%
  • Ambulatory Care: 26%
  • Emergency Assessment Unit / Surgical Assessment Unit: 42.5%

So, 76% of patients avoid A&E and 7.5% of patients are avoiding hospital altogether. This reduces the pressure on A&E considerably.

But why do 24% of calls result in the patient still ending up in A&E? The answer is that, if ambulatory or EAU/SAU provision is full, the patient is sent to A&E but this is a last resort.

2. Paediatric Advice & Guidance reduces urgent referrals / admissions significantly

The Paediatric Advice & Guidance line is there for GPs who are thinking of sending in a patient that day but who feel they may benefit from a discussion with a paediatrician. According to GP and consultant user feedback, in many cases the Advice & Guidance has been sufficient for the GP to keep the patient’s care with them, avoiding an urgent referral / admission.

What has the hospital data found, though?

Comparative data for the 6 month period Apr – Sep 2016/17 shows a 28% reduction in the number of GP referrals to PAU in 2017 compared to 2016. This is a reduction in activity of 191 cases over 6 months. Note: the purple bars show the proportion of total referrals that are arriving via Urgent Connect. For example, in May 2017 there were a total of 100 referrals, of which 71 came via Urgent Connect.

As with many areas, this data may have been impacted by other initiatives to reduce avoidable admissions. Nonetheless, Consultant Connect’s own user outcome data estimates that over 160 urgent referrals / admissions were avoided during this 6-month period, which is indicative of the impact of the service.

3. Luton GPs use the service – a lot!

The Urgent Connect service at Luton & Dunstable is high volume. In Luton alone the service typically receives 450 – 500 calls per month, with the majority of calls (c. 75%) being to the GP Liaison line.

Hospital navigation and Advice & Guidance benefits scale in a straight line with usage – if your telephone services are effective at keeping patients out of A&E, the more GPs use the service the more patients will benefit. This is clearly demonstrated in Luton.

Conclusion

Luton & Dunstable Trust and Luton and Bedfordshire CCGs are embracing the power of improved communication between GPs and secondary care clinicians to get patients the right care, first time – and keep them away from A&E.

We’re not saying telephone Advice & Guidance is the solution for congested A&E departments, but we are saying it can be part of the solution. If GPs are helped to find and choose better alternatives for their patients, all GPs would only use A&E as a last resort. Similarly, if GPs can be helped by specialists to keep a patient’s care with them, they will try and avoid the upheaval of a hospital visit for their patient.

If you would like to discuss implementing an Urgent Connect project in your area THIS WINTER, please arrange a meeting and demonstration with us by emailing hello@consultantconnect.org.uk or by calling 01865 261467.