“The tele-triage service has been massively innovative in preventing admissions to hospital. Our staff team has grown in confidence in our ability to deal with complex situations and we are more involved in our residents’ care when they are in hospital as we are kept updated by the tele-triage team.”
Brian McNaught, Deputy Manager, Birkenhead Court Care Home
Overview

A 24/7 clinical tele-triage service for care homes in Wirral has resulted in an average 66% decrease in the number of NHS 111 calls and a 10% decrease in ambulance conveyances to A&E for care home residents.

The service is delivered by all the area’s health and social care partners with funding support from the Innovation Agency. Care homes have been provided with iPads and secure nhs.net email addresses, and staff have been trained to take basic observations and equipped with blood pressure monitors, thermometers, urine dipsticks and oximeters.

When a resident becomes unwell, care home staff use Skype to consult a nurse practitioner or GP. The teletriage nurse uses the observations taken by care home staff, and a visual assessment of the patient to provide clinical advice and management without the patient needing to leave the care home. This includes advice, prescription, same day GP visit, onward referral, monitoring or supporting end of life care. Following their assessment, senior nurses coordinate the appropriate follow-up care.

Challenge / problem identified

Wirral has a high number of care homes, 76 in total, and an increasingly older population with a rapid increase in the number of A&E attendances and non-elective admissions from care homes over the past few years. Evidence shows that many care home residents are admitted to hospital when they become ill, even though it’s often not the most appropriate place for them. Being admitted can have a severe impact on people both physically and mentally, so it’s vital they are only admitted when it is clinically necessary.

Wirral Health and Care Commissioning were looking for innovative initiatives that would, for its local care homes:

  • Reduce ambulance calls and conveyances
  • Reduce A&E attendances and admissions
  • Improve patient experience
  • Provide quicker access to clinical assessment than via NHS 111
  • Provide care in the patient’s place of residence.
Actions taken

Wirral invested in a 24/7 clinical tele-triage service in 2017-18 for all older people’s residential and nursing homes in the borough.  The service is delivered by all the health and care partners in Wirral and was supported by the Innovation Agency.

Care homes have been provided with HD iPads and secure nhs.net email addresses, and staff have been trained to take basic observations and equipped with blood pressure monitors, thermometers, urine dipsticks and oximeters.

An application was made to the Innovation Agency’s Transformation Fund 2017 and £33,000 was granted, to fund the expansion of the Wirral tele-triage system to 30 care homes, to provide additional services such as speech therapy, tissue viability and palliative care.

Impacts / outcomes 

Since its launch in 2017 the teletriage service has been rolled out across all 76 care homes in Wirral. It is available 24 hours a day, 365 days a year, and replaces the NHS 111 service for care homes.

The service receives around 300 calls a month from care homes, and only 12% of patients require hospital treatment (usually for an x-ray). The service has helped avoid hundreds of unnecessary hospital admissions, providing direct support to care home staff, a better outcome for patients and reduced costs to the NHS.

In terms of impact:

  1. There has been a 66% reduction in NHS 111 calls from Wirral care homes from June to November 2018 compared to the same period in 2017. This has been fairly consistent over the previous 12 month periods:

  2. There has been a 7% reduction in ambulance conveyances to A&E from care homes between June and November 2018 compared to the same period in 2017. There has been quite a variance on this metric over the preceding 12 month period, with the highest percentage reduction being 13% for the period March to September.

Separate work is ongoing in the acute hospital to undertake a weekly snapshot audit of all patients going to Wirral University Teaching Hospital by ambulance, and the appropriateness of this transfer. This will help to improve the tele-triage service and its approach for assessing ambulance transfer requirements for any patients coming from care homes.

“Our tele-triage service means unwell patients are now supported within their care home, rather than facing the frightening and disruptive prospect of ambulances and hospital departments.

“As well as providing better care and better health for patients, it provides better value for the NHS too.”

Val McGee, Chief Operating Officer of Wirral Community NHS Foundation Trust

Plans for the future

The project is being mainstreamed into service delivery within Wirral Community Health and is currently running at capacity. The delivery team are looking at developing a business case to expand the team to take on additional patients as demand is expected to grow.

Other opportunities being explored include:

  • Potential to extend to other residential settings such as learning disability and mental health
  • Potential investment in other areas such as telehealth
  • Further integration with Wirral’s Single Point of Access development
  • Possibility of expanding skype consultations to other services (speech and language, tissue viability)
  • Possible partnership with community paramedics.
Start and end dates

The project started in June 2017 and is now part of mainstream service delivery for Wirral Community NHS Trust. Regular reviews are taking place to ensure the service remains effective and that there is appropriate capacity to meet service demand.

Contacts

Project contact for further information

Sara Shaikh, Commissioning Manager -Unplanned Care, Wirral Health and Care Commissioning
T: 0151 541 5454
E: [email protected]

Media contact

Caroline Kenyon, Director of Communications and Engagement, Innovation Agency
T: 01772 520280 or 07950 866394
E: [email protected]

Care home tele-triage reduces A&E attendances