COVID-19: Supporting urgent and emergency care patient flow
Supporting system wide plans to fight the COVID-19 pandemic
The Utilisation Management (UM) Unit, part of Health Innovation Manchester, has refocussed their urgent and emergency care (UEC) clinical and analytical expertise to support system wide plans to fight the COVID-19 pandemic.
They are working collaboratively with multiple GM partners and providers to ensure pathways across UEC are safe for patients and staff and are sustainable during and after the current COVID-19 pandemic. They are also providing clinical leadership and insight into the development of HInM’s digital programmes of work.
As part of their work, the UM Unit are providing clinical leadership and insight to support the development of Health Innovation Manchester’s accelerated programmes. These are:
The GM CAS was established in 2019 to test the assumption that a proportion of low priority calls to NHS 111 and 999 could be managed by clinical assessment over the telephone and reduce the need to transfer patients to an Emergency Department (ED).
The planned expansion of the CAS coincided with the start of Covid-19 pandemic and therefore the need to accelerate this work programme became paramount. The UM team has led the development and set-up of a clinical reference group for the CAS and also ensures that any related work across the digital programmes is linked the outset, such as digital care homes. Further clinical groups are being established for End of Life care, Mental Health and Paediatrics, to ensure the provision of best practice for these patient cohorts by the CAS.
The UEC response at hospital sites aims to address delays to speciality assessment and ensure that patients that can be managed via a “same day” episode of care are not admitted to hospital. The first phase of this work programme is complete. The UM team has supported the work to ensure that patients with stable clinical presentations who don’t require a time critical intervention are best managed by the relevant clinical speciality, in an assessment area away from the ED. The team is currently benchmarking ED streaming activity across all the 10 localities prior to the development of measures to assess the impact.
The UM team is providing expert clinical insight and support for the development of the digital care homes programme. They are also ensuring alignment with the new Discharge to Assess (D2A) pathway to enable hospital discharge back into community services or the patient’s usual place of residence, including Care Homes.
The role of UM Units analytical team is proving to be invaluable in driving forward the evaluation elements of the GM UEC Transformation and Improvement programme. The team is co-designing the evaluation frameworks for the CAS and both the hospital-based and community-based response. There is a significant opportunity to review the progress made with redesigning patient pathways and measuring the quality and safety improvements that have been made. Systems have responded to the COVID-19 pandemic by rapidly redesigning patient pathways and flow in primary and secondary care. Understanding the quality and safety benefits and any unintended consequences of rapid and agile change will be an important part of the pandemic recovery phase.
The analytics team have developed a GM UEC COVID dashboard which analyses the changes in UEC flow at a GM and locality level as a result of COVID-19. This has provided great system insight and supports clinician experience. Further developments are being taken forward in collaboration with the GMHSCP and Transformation Unit.