Understanding patient pathways and the impact of UTIs on emergency admissions in MS. Sue Thomas CEO

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1 Understanding patient pathways and the impact of UTIs on emergency admissions in MS Sue Thomas CEO

2 Aim Highlight from national and local statistics the impact MS has on the NHS Explain how integrated pathways can support better care Illustrate which pathways might bring improved patient outcomes and service efficiencies Clarify steps to achieve change

3 Top 10 neurological conditions requiring hospital admission (data from 9 Clinical Networks) 600, , , , , ,000 - Motor neurone diseasespinal cord injury Migraine CNS infections Hydrocephalus Acquired brain injury Multiple sclerosis Parkinson s Neuropathies Epilepsy Data source NHiS 2014

4 Admissions per 1000 pwms MS: The national picture: Measuring the burden of hospitalisation in Multiple Sclerosis: A cross-sectional analysis of the English Hospital Episode Statistics database Non-elective admissions for people with MS cost the NHS 43m in 2013/14, an average of 1820 per admission The admission cost was similar, regardless of whether MS was coded as a primary or secondary reason for admission Financial year elective admissions non elective admissions

5 North Bristol Secondary care data is taken from the English Hospital Episode Statistics (HES) database produced by the Health and Social Care Information Centre (HSCIC, Copyright , re-used with the permission of the Health & Social Care Information Centre. All rights reserved.

6 Reasons for admission The most common reasons for non-elective admissions in MS were bladder and bowel issues, MS itself (including MS relapse), and pneumonia / respiratory tract infections. Urinary Tract Infections accounted for 14% of emergency MS admissions (compared to only 3% of all population admissions) and cost an average of 2556 per admission. The total cost for all bladder and bowel related admissions in 2013/14 was more than 11m. Respiratory issues accounted for more than 5.5m of nonelective admissions costs in 2013/14. Whilst not all of these will be directly due to MS, this remains significant.

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8 Commissioning for Value packs

9 Routes for admission MS & Inflammatory Neurology General medicine Various (MS & Inflammatory) Urology Accident & emergency General surgery Trauma & orthopaedics Rehabilitation Geriatric medicine Cardiology Outer = Relative % admissions Middle = Relative % cost Inner = Average cost per admission

10 Comorbidity Multiple Sclerosis

11 HEADACHE, EPILEPSY MOVEMENT DISORDERS, MS, NEUROMUSCULAR high admission rates shorter length of stay (LOS) high zero bed day rates (ZBD) low excess bed days (EBD) high readmission rates lower admission rates longer length of stay low zero bed days high excess bed days low readmission rates Put effort into front door emergency presentations education referrers & emergency staff rapid review (neurology) Put effort into early supported discharge admission prevention enhanced primary care management of prominent neuro LTC co-morbidities

12 Integration An Integrated care pathway (ICP) determines locally agreed multidisciplinary and multi-agency practice, based on guidelines and evidence where available for a specific patient/client group. It forms all or part of the clinical record, documents the care given, and facilitates the evaluation of outcomes for continuous quality improvement. Overill: 1998

13 We achieve integrated pathways through a team approach Not just about any one service or person It s a team approach to management The integrated pathways that develop will be based on us all working together

14 What will we achieve? One single pathway relevant to everyone across all disciplines including all aspects of care...from diagnosis to end of life. Make sense?!

15 MS journey First symptom GP Hospital appointment with neurologist Diagnosis of MS Time to think Initial management plan Care closer to home GP Investigations MS nurse specialist Relapsing remitting Rehab Social care Living life Secondary progressiv e Primary progressive Carer support Emergency care GP MS nurse specialist Neurologist

16 Suffolk integrated care pathway

17 Why Richmond decide to do it? To provide a consistent patient pathway from onset of symptoms to end of life. Currently this is a very confusing and inequitable experience for patients, including people lost to follow up, recurrent emergency admissions for preventable episodes To facilitate Patient access to appropriate, responsive & timely health & social care services very varied- needing Joined up care To enable Patients & carers to be involved in managing their disease and decisions around their care needs To identify services that were lacking neuropsychology/sexual dysfunction clinic To meet all relevant staff & engage/impassion them in improving care for MS To ensure access to emerging treatments for MS which are improving long term prognosis, reducing disability & improving outcomes(reducing costs to patient, Health & Social care) To design and implement a gold standard ICP in Richmond using national standards for MS To identify funding needs for MS services TO CHANGE THINKING TO BEING PROACTIVE, PREVENTATIVE, EDUCATIONAL

18 Benefits of Integrated Care Improve outcomes for patients at the minimum necessary cost; Greater support for self care for patients Create access to better, more integrated care outside of hospital; Reduce unnecessary hospital admissions and enable effective working of professionals across provider boundaries. Patient experience and quality of care will be improved through stricter adherence by all health professionals to evidence based care protocols uses across multiple organisations The successful provision of high quality services in the community Active & Preventative care management for people with long term conditions ( to prevent deterioration of LTNC and use of acute services where possible)

19 Process for the Richmond ICP in MS 1. Formation of core professional group/ Initial meeting Literature and data review Initial lines of enquiry: scene setting User survey Stakeholder event and solutions brainstorming Creation of ICP- ongoing 7. Consultation professionals and service users Launch and actions taken forward 9. Clinicians begin to work in line with pathway as far as possible 10. Meet with commissioners to discuss onward planning

20 Richmond gold standard - example

21 UTI Pathway

22 HEADACHE, EPILEPSY MOVEMENT DISORDERS, MS, NEUROMUSCULAR high admission rates shorter length of stay (LOS) high zero bed day rates (ZBD) low excess bed days (EBD) high readmission rates lower admission rates longer length of stay low zero bed days high excess bed days low readmission rates Put effort into front door emergency presentations education referrers & emergency staff rapid review (neurology) Put effort into early supported discharge admission prevention enhanced primary care management of prominent neuro LTC co-morbidities

23 Multiple Sclerosis How could service quality improve? Access - SNs covering evenings to 8pm and Saturday mornings (many MS patients are young and at work) Education courses for newly diagnosed patients Clinics in community locations More outreach More engagement at A&E resulting in zero bed day admissions. More neuro education for community teams, GPs

24 Acknowledgement Dr Chris Kipps SCN Lead Wessex Dr Paul Molyneux Suffolk Ruth Stross MS Nurse Specialist Richmond & Hounslow LinkedIn