This project co-ordinates and supports patients with an approach which considers in-patient care and community support, using an extended multi-disciplinary approach including general practitioners, nursing, therapy and social care input, supplemented by specialist/secondary care involvement where appropriate.
The aim is to manage many of these patients in the community without the requirement for frequent unplanned hospital admissions.
Aims of the Project
- To reduce unplanned admissions to hospital
- To reduce the length of stay for patients in hospital who are known to the project
- To provide a consistent joined up approach
- For patients to receive the right care, in the best place by the right service in a timely manner thus leading to improved care and possible outcomes for patients.
- Improve the co-ordination of care and treatment for patients across services
- Improve patient choice and compliance.
- Improved patient experience of those accessing our services
- Ensuring that any unplanned attendances to hospital require acute care and are not due to gaps in overall patient management.
- Improve the financial implications for the health economy regarding treatment and care.
The results have been better than expected on supporting Home First and admission avoidance.