The HIU Project builds on a previous pilot which considered a cohort of 3 patients. Evaluation of this pilot proved that following intervention, after the creation and initiation of a care plan, all activities for 2 out of 3 patients decreased to zero.
The HIU project works through a multi-disciplinary team (MDT) approach by agreeing care/intervention plans for frequent users who impact on the Accident and Emergency department (A&E) at Colchester General Hospital (CHUFT), the East of England Ambulance Service (EEAST) and other services in the NEE system.
MDTs are led by a senior clinician and individuals discussed are selected based on an agreed set of criteria. The MDT representation includes clinicians from the ambulance service, acute trust, mental health, community services, 111 and Out of Hours GP services.
In addition, there is regular collaboration with Social Care, voluntary services, police and borough Councils. The outcomes of these meetings are plans and early warning systems to support HIUs to live well at home, enable them to access the right care at the right time and as a consequence reduce A&E and Ambulance activities.
The project is managed on a day to day basis by the High Intensity User Co-ordinator who has been appointed on a 12 month fixed term contract basis. This post has been pivotal to the success of the project enabling data to be produced and analysed; processes to be formally created and established; and momentum to be maintained between MDT meetings.
Challenges: The main challenges were information governance and data sharing issues which were overcome by collaboration between all parties and written agreements. Despite vast improvements, engagement and capacity for MDTs remains an on-going challenge.
Achievements: One of the main achievements was the acquisition of historic data from CHUFT and EEAST and realising benefits for the first cohort (46 individuals included in the Phase1).
HIUs spent a minimum of 2 months on the MDT list and maximum of 12 months with an average time of 5 months. Average cost savings per person was £1,577.80 with a total saving of £72,578.80 for the Phase 1 cohort.
Furthermore, activities for Ambulance dispatches and conveyances as well as A&E attendances and admission fell on average by 36%.
Lastly, we have established and are continuing to improve the good rapport and collaborative working with all parties involved with the MDT and HIUs.
Future Objectives: We are planning to consider 80 HIUs as part of our Phase2 cohort. The project is also expanding to include specific areas such as childrens and frailty. One of the key tasks for the High Intensity User Co-ordinator is to identify the future potential for this work and where it could sit as business as usual.