BLOG: Working together to detect deteriorating patients in Somerset

Last year a pilot project evolved across the Somerset community to improve the way deteriorating patients in the community are responded to. In this blog, South West Academic Health Science Network (SW AHSN) deteriorating patient lead, Harriet Matthews, reveals how the project has boosted detection and communication between care homes and GP practices – and provides top tips for teams wanting to do the same.
In January 2019, multiple organisations across Somerset – Yeovil District Hospital NHS Foundation Trust, Somerset Clinical Commissioning Group, Somerset Primary Link, South West Ambulance Service NHS Foundation Trust, local nursing homes and GP surgeries, and the SW AHSN –  came together to explore the challenges in identifying, escalating and responding to patient and resident deterioration across the patient pathway.
With funding from Health Education England, the organisations had one aim – to identify where improvements would mean deteriorating patients and residents were recognised promptly, concerns were escalated effectively and appropriately, and a timely response was triggered to ensure the right care was delivered in the right place and at the right time.

The activity

Over the last year, more than 350 staff have been trained in awareness of deterioration and sepsis in three nursing homes and three corresponding GP surgeries in Somerset. This training familiarised staff with Restore2™ and the National Early Warning Score (NEWS) 2.
Restore2™ is a physical deterioration and escalation tool designed for use in care or nursing homes. The tool incorporates NEWS2, a score initially used in acute health settings to determine the severity of a person’s illness and standardise assessment and response to the deteriorating patient. Restore2™ also determines what is normal for the resident and detects ‘soft’ signs of deterioration (changes in a patient’s physiology which are noticeable without taking observations). The tool prompts a discussion about end-of-life preferences as well as the SBAR (Situation, Background, Assessment, Recommendation) tool and action tracker.

The impact

Data reveals the project has been transformative, with benefits including:
Improved communication – Care homes and GP surgeries have reported improved communication, exchange and escalation of information. Providing more concise information has enabled more efficient use of staff time and resources, and as a result the relationship within and between organisations has improved. By working together on a common problem organisations have broken down barriers by collectively identifying solutions and sharing information across the patient pathway, including both qualitative and quantitative data to demonstrate impact.
More appropriate referrals – Care homes are calling 999 more appropriately and an increased number of NEWS2 scores are being recorded at the point of referral to hospital, as well as during the patient journey.
Stepping outside of silos – Acute trusts are more aware of the challenges facing primary care and vice versa, leading to more informed decision-making and working relationships.
A common language – Care providers across primary and secondary care are beginning to use a common language to communicate critical information using Restore2™ and SBAR tools.
Empowered staff – Training and provision of a tool which enables staff to escalate concerns and convey information effectively has meant that care home staff feel more valued and more confident.
Saving lives – Care home managers are reporting that use of Restore2™ by staff is enabling earlier identification of deterioration, ensuring appropriate treatment is provided in a timely fashion, avoiding hospital admissions and reducing harm.

Starting a community-to-acute project in your region?

Starting a community-to-acute project is a fabulous way to empower care home and GP staff, enhance relationships between health care providers, and work with partners across the whole patient pathway to ensure early and appropriate identification of deteriorating patients and a timely response. Here are my top tips to help you.

• Form an agile, cross-organisational project team to cover all organisations involved in the patient/resident pathway. Hold regular meetings with all involved staff (and even patients!) to review project progress and find solutions to any challenges.
• Identify organisations with a passion and drive for change, and who have commitment and support from senior management.
• Use QI methodology to provide structure to help you identify your aims, change ideas and measures, monitor and adapt your project, and identify its impact.
• Work with your QI hub or plan to build QI knowledge into your organisation.
• Identify your measures at the outset.
• Make sure there is an allocated person to collect and analyse data – what by when?
• Use the resources already developed.
• Join the SW AHSN’s regular Deteriorating Patient Improvement Network (DPIN) meetings to share learning and experience with others.
• Explore valuable Restore2™ resources by West Hampshire Clinical Commissioning Group.

To keep up-to-date with the latest news and insights across deteriorating patient care, sign up to the quarterly Deteriorating Patient Improvement Network (DPIN) bulletin. Contact Harriet Matthews (harriet.matthews@swahsn.com) to subscribe or for more information about developing community-to-acute patient pathways.