1. TIPS REGARDING FORMATTING
Referring patients directly into community Rapid Response pathways from the NHS 111 IUC Clinical Advisory Service
TIPS REGARDING FORMATTING
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Finding ways to reduce low acuity hospital admissions
Across London, there is inconsistency in the use and knowledge of Alternative Care Pathways (ACPs), which are designed to safely and efficiently provide urgent care response to patients in the most appropriate possible clinical setting for them. Due to inconsistencies in community service commissioning and variation in provision and responsiveness across London, clinicians and referrers lack the confidence to refer patients to ACPs, such as rapid response services, when these could help to avoid hospital admissions and potentially long hospital stays. This is compounded by high staff turnover, which means that local knowledge of referral pathways is lost over time.
What is HLP doing to support?
HLP has convened a Task & Finish group, chaired by Dr James Ray (London UEC Regional Clinical Lead) made up of representation from across London, including commissioners, IUC providers, strategic leadership from STPs, and LAS. As well as providing a platform to share learning from local initiatives to enable referrals into rapid response services from IUC CAS, the group has agreed to support and inform the development of pilot pathways in North Central London (patients with catheter problems), and South East London (patients who fall but are not injured).
This work is being enabled by support from NHS Pathways, the London IUC and DoS team, the NCL Rapid Response Group and the SEL Falls Network.
Scope of initial impact from pilot sites
Barnet
Enfield
Haringey
Camden
Islington
City
Barking and Dagenham
Hackney
Havering
Newham
Redbridge
Tower Hamlets
Waltham Forest
Croydon
Richmond
Wandsworth
Kingston
Merton
Sutton
Brent
Ealing
H&F
Harrow
Hounslow
K&C
Westminster
Hillingdon
Lambeth
Bromley
Bexley
Greenwich
Lewisham
Southwark
North Central London pilot – catheter pathways
South East London pilot – falls pathways
TIPS REGARDING FORMATTING
Use graphic elements, like boxes, to highlight each section of your poster.
Use space to create emphasis.
Use no more than 2-3 colours, and dark type on a light background.
Conclusions first, keep them short and to the point in the upper left-hand corner.
Simple graphs are effective graphs.
Make the text big enough to read.
Use Arial or Lato font.
ALWAYS left align the text.
Keep your headings the same size and style throughout.
Avoid chaos, keep the layout easy for the eye to follow.
Images and graphs say more than words, so keep your poster visual.
If you are using a photo, avoid web images – use at least 150 dpi, but no more than 300 dpi.
Don’t forget any other logos where necessary.
Patient need identified after speaking to a senior clinician via the IUC CAS
IUC CAS clinician attempts direct referral into Rapid Response
Request rejected
- Ambulance dispatched
- Conveyance to Emergency Department
- In-patient admission
Current IUC scenario:
Current issues:
Inconsistency in response times and opening hours of rapid response providers make it difficult for CAS clinicians to know if a referral is possible and safe to transfer care
Rapid response providers generally want to triage referrals, even when a senior clinician from the CAS has just done this; some will simply refuse to accept the referral from 111 IUC.
Rapid response providers are nervous that opening up referral pathways will increase demand to a level that they cannot cope with. There is currently not enough data available to demonstrate whether or not this would be the case, hence the need to pilot single pathways in different areas, to test demand for the rapid response pathways.
Next steps:
Data collection: current rapid response providers for conditions-specific referrals, capacity, skill mix, referral criteria etc.
Local stakeholders to conduct pathway mapping to identify unwarranted variation
IUC referral pathway development, test and pilot
To find out more, or to get involved, please contact:
Dan Heller, on
@healthyLDN

2. TIPS REGARDING FORMATTING
Evaluating the NHS 111 Star Line Service
TIPS REGARDING FORMATTING
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Conclusions first, keep them short and to the point in the upper left-hand corner.
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Make the text big enough to read.
Use Arial or Lato font.
ALWAYS left align the text.
Keep your headings the same size and style throughout.
Avoid chaos, keep the layout easy for the eye to follow.
Images and graphs say more than words, so keep your poster visual.
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Don’t forget any other logos where necessary.
Supporting the next phase of development and increasing utilisation for the 111 Star Lines
Prior to the introduction of the star lines in January 2017, the number of 999 calls from care homes was increasing year on year by a rate of 7%, and at its highest, 3273 care home incidents were attended to by 999 in December Against this backdrop, the NHS 111 Star Line service, which was designed to enable particular callers to use their telephone key pad to connect quickly with a GP in the NHS 111 contact centre, has had an impressive impact on emergency services in London:
Prevented previous year-on-year increases (7% annually) of care homes calling 999 post star line introduction
88% LAS crews using the *5 line provided positive feedback regarding their experience of using the service (*5 is for LAS crews, *6 is for care home staff, and *7 is for Rapid Response nurse teams and domiciliary care workers)
95% of calls closed or referred to primary/community care by a GP in the Clinical Assessment Service (CAS), following advice to the star line caller
Only 4% of cases require ED or ambulance referral after GP consultation, compared with overall 111 service (10%)
Despite its positive impact, utilisation of the Star Line service fell from 4528 calls across London in December 2017, to just 2629 calls in December 2018; a 42% reduction. Healthy London Partnership were keen to understand more about why this drop-off occurred, and what would help to maximise the positive impact it has had.
The NHS England End of Life Care Clinical Network was also interested to know more about how the Star 6 line (for care home staff) can further support patients in care homes towards the end of their life. A joint evaluation project was agreed, with support from the Health Innovation Network.
Designed to enable particular callers to use their telephone key pad to connect quickly with a GP in the NHS 111 contact centre. •
*5 is for LAS crews attending incidents at patient’s homes or care homes.
*6 is for care home staff who require urgent clinical advice and support.
*7 is for Rapid Response nurse teams and domiciliary care workers.
*Line calls are routed to a NHS 111 service adviser who takes the patient details and transfers the call to a GP 24/7 - if the GP is already on a call there is a guaranteed call back within 20 minutes
Fig. 1: The growth and decline in usage of all the star lines across London
Call volume Oct - Dec 2017
Oct
Nov
Dec
3261
3284
4528
Call volume Oct - Dec 2018
1806
1846
2629
Percentage change
-45%
-44%
-42%
Fig. 2: The decline in usage of all star lines across London from Oct – Dec 2017, to Oct – Dec 2018
What did HLP do to support?
HLP, together with the NHS England End of Life Care Clinical Network and the Health Innovation Network have collected data from a variety of sources:
Conducting end-to-end reviews of Star Line and 111 calls
Surveying the users of the services (LAS crews for *5, care home staff for *6, and rapid response teams for *7). A total of 230 survey responses were received
Using data from a London-wide Star Lines dashboard, which shows activity, utilisation transfer/call-back times (the time it takes for a senior clinician to call back the initial star line user) and the outcomes of calls
TIPS REGARDING FORMATTING
Use graphic elements, like boxes, to highlight each section of your poster.
Use space to create emphasis.
Use no more than 2-3 colours, and dark type on a light background.
Conclusions first, keep them short and to the point in the upper left-hand corner.
Simple graphs are effective graphs.
Make the text big enough to read.
Use Arial or Lato font.
ALWAYS left align the text.
Keep your headings the same size and style throughout.
Avoid chaos, keep the layout easy for the eye to follow.
Images and graphs say more than words, so keep your poster visual.
If you are using a photo, avoid web images – use at least 150 dpi, but no more than 300 dpi.
Don’t forget any other logos where necessary.
The final evaluation will be due imminently. Below are some emerging findings suggesting there is some variation in:
The understanding of the service that users of the star lines (LAS crews, care home staff and rapid response teams) have, including how to access the lines, the number to call, and number to ring
Response time / operational model – the agreed advertised time for a GP call-back is 20 minutes, but the evaluation has found this is not always provided, and it is not always what the providers expect to deliver
Expectations and understanding of the purpose of the lines. For example, whether it is for clinical advice, or to be used for more routine tasks
However respondents of the survey, and regular feedback collected from star line users also indicated that the service is helpful and helped to avoid ambulance conveyances and hospital admissions. This reinforces the outcome data from star lines, such as the prevention of year-on-year increase in 999 incidents (from care homes), 95% of calls either being referred to primary care or closed, and only 4% of cases requiring ED or ambulance referral. This demonstrates the benefit to UEC systems and patients of the Star Lines, and the reason it is so important to increase their utilisation.
What next?
This work is due to be completed in summer The recommendations will be used to inform the continuous improvement of the service. By listening to our users, and understanding the services’ pros and cons, we can support the future development and communications of the Star Lines.
By supporting the development of new or improved elements to the service (eg. a see & treat and refer & leave model for LAS crews who call * 5, or reducing 999 call volume from care homes), the wider UEC and IUC system should benefit.
To find out more, or to get involved, please contact:
Dan Heller, on
@healthyLDN