Abstract
Introduction
There is continuous increased demand on the NHS, while resources are finite. Developing pathways with Integration and streamlining of services is crucial to achieve good outcome and better use of resources. Falls service is a good example. In Dudley, three separate services existed for managing falls: a local authority team, a NHS therapy team and a Consultant-led Falls & Syncope clinic. We collaborated and reorganised the services to improve patient care and achieve better outcome.
Methods
We integrated services into one pathway, where patients are triaged to the relevant service based on clinical need via a Single Point of Access. One multifactorial assessment- based on NICE guideline CG161 and Quality Standard QS86- was developed, which is completed by all services (streams). This allows their assessment to be transferred to another stream if clinically indicated, saving repetition/duplication. An extensive training programme was delivered to up-skill staff across the pathway in completing areas of best practice (e.g. postural BP measurement, balance/mobility assessments, cognitive assessment, FRAX score, medication issues). Additionally we established a Falls MDT meeting with representation from all streams, to discuss complex cases, and developed a shared, electronic database to track patient journeys and monitor service outcomes.
Results
Falls admission rate decreased by 29.4% for patients 65 y and over and 25.2% for 80+. This equates to 433 fewer falls compared to peak rate; saving an estimated £3.4million. Also, hip fracture admission rate decreased by 19.2% for patients 65 y and over and 23.5% for 80+. This equates to 91 fewer hip fractures compared to peak rate; saving an estimated £1.3million. Much improved service collaboration and resource sharing.
Conclusion
A collaborative approach between organisations, utilising existing resources in a system that places patients at the heart of the service, improves patient experience and outcomes, alongside significant financial savings.