Value in Healthcare Awards: Value and Improvement in Acute Service Redesign

Chelsea and Westminster Hospital Foundation Trust and Central London Community Healthcare Trust: Boundaryless patient flow across acute and community emergency care pathway

Judges said: The winner offered an excellent and grounded piece of work, demonstrating solid outcomes. The plan was well integrated and recognised the need for close system working and effective partnership.

Chelsea and Westminster Hospital Foundation Trust and Central London Community Healthcare with NWL Clinical Commissioners jointly initiated the Emergency Care Pathway Programme to improve boundaryless patient flow between their services. They partnered with GE Healthcare Performance Solutions to achieve this.

The first step was to set up a GP led programme board drawing together core members with key partners: London Ambulance, social services and CCG commissioners. The objectives were:

• to reduce emergency admissions by 5 per cent on the previous year;
• deliver earlier supported discharge and rehabilitation; and
• keep patients safely at home.

The partners built a model simulating the end to end patient pathway which allowed Chelsea and Westminster to understand the interconnected impact of change on the whole system.

Rapid access acute medical and surgical clinics were developed, offering an alternative to admission for ambulant patients requiring urgent consultant opinion. This has contributed significantly to delivering a 6.5 per cent year on year reduction in emergency admissions at C&W in 2013-14.

Detailed analysis was also undertaken with CLCH around the key patient cohort of frequent attenders and/or admitters to C&W. Only 40 per cent of this cohort were already known to CLCH, and, on average, from seven to 17 beds were consumed at C&W by such patients, equivalent up to 502 bed days a month. This is a potential saving of up to £972,000 in costs within the acute setting.

Among other benefits were a reduction in emergency admissions by nearly 6.5 per cent on last year’s volumes, which is over 1,500 fewer admissions, and also excess bed days reducing by 30 per cent.

• See all the winners of the Value in Healthcare Awards 2014
• See the full list of award judges

Finalists

• Birmingham Women’s Foundation Trust: Hyperemesis Day Centre - highly commended
• Heart of England Foundation Trust: Supported integrated discharge team   
• NAViGO Health & Social Care CIC: Providing services our families would be happy to use    
• North West London Hospitals Trust: Introduction of ARFI elastography into the patient pathway for chronic liver disease
• NHS Tower Hamlets Clinical Commissioning Group: Accident and emergency streaming project      
• United Lincolnshire Hospitals Trust: Admission avoidance in Lincolnshire   
• Worcestershire Acute Hospitals Trust: Stroke service   
• Wrightington, Wigan and Leigh Foundation Trust: Maternity triage   
• Chelsea and Westminster Hospital Foundation Trust: Boundaryless patient flow across acute and community emergency care pathway