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With evidence that a significant proportion of acute hospital admissions are avoidable, healthcare commissioners throughout the country are continually searching for effective initiatives that avoid unnecessary emergency admissions.

Wolverhampton CCG introduced a 12 week ‘step up service’ pilot to achieve this aim.

The CCG needed to ensure that not only did the pilot service meet its primary objective but it could also demonstrate clinical compliance, appropriate patient care and cost effectiveness. Arden & GEM designed and produced an evaluation process. As a result of the evaluation report, the step up service has now been commissioned on an ongoing basis.

The challenge Avoidable acute hospital admissions can have serious repercussions for bed occupancy and planned (elective) treatments.

In January 2017, Wolverhampton CCG commenced a ‘step up service’ pilot to provide care to patients where current services were unable to support them in their own home due to a health crisis but an acute admission was not medically required.

The service was able to take advantage of unused capacity available within an existing step down contract with a local nursing home.

The commissioner and provider agreed to a three month pilot, after which a thorough evaluation would be completed before making long term decisions about the future of the service.

Our approach Arden & GEM was tasked with completing a service evaluation. Our Specialist Strategic Service Improvement team utilised our tried and tested evaluation methodology to design a process, consisting of both qualitative and quantitative analysis, to determine:

• Is there evidence that the service is meeting its objectives?

• Should the service be formally commissioned or stopped?

• Does an alternative approach to the current model need to be considered?

A range of qualitative information was collated through interviewing the rapid intervention team (service referral point), the commissioned GP with responsibility for the care home, CCG staff and care home staff. A quantitative review took place covering:

• A clinical compliance audit, conducted by a geriatric consultant and specialist lead nurse practitioner, to determine appropriateness of admissions into the step up care setting

• Data collected on the patients using the service including age range, length of stay, discharge destination and any delays

• An evaluation of cost against alternative bed provision

• Patient/ family experience feedback data, collated via a questionnaire developed specifically for the pilot.

The CCG was fully informed and involved on the progress of the evaluation via a series of meetings and briefings.

The outcomes As a consequence of the evaluation findings, the step up care service has now been fully commissioned

A series of recommendations was made to improve the quality and efficiency of the service covering clarity of role and responsibilities, clinical review, training requirements and value for money.

In particular, the stakeholder interviews identified a number of service enhancements – from supporting an e-learning programme to assigning a care home physiotherapist – which have all been accepted and actioned by the commissioner and provider.

The recommendations made for improvement will ensure that the service continues to develop to meet the needs of patients while better fulfilling its aim of avoiding unnecessary admissions to acute care.

“The Arden & GEM Programme Manager was very professional and very competent. He kept me fully informed of progress and we met and discussed next steps on a regular basis. The draft stages of the evaluation report were received on time with all additional comments acknowledged, discussed and actioned where appropriate. The final report was incredibly detailed, informative and very well received by our Board who were able to make an immediate decision regarding commissioning the service fully.”  Karen Evans, Solutions and Transformation Manager

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