2. During 2011 COPD in Christchurch accounted for: 1,256 admissions (3.5 per day) 5,952 bed days (two wards in winter) 1 in 4 being readmitted within 28 days 4 out of 5 arriving by ambulance

3. Diabetes hospital admission rates OECD

4. COPD hospital admission rates OECD

5. COPD admissions unaffected by earthquake (other admissions down significantly)

6. Admissions from ambulatory sensitive conditions (ASH) – the potential to do things differently The leading 8 ASH conditions account for 79% of ASH admissions

7. Admissions to ChCh hospital for COPD – milder disease increasing

8. ED attendance mode for admitted COPD patients

9. COPD admission day of week Count

10. ED attendance with Resp. disease (>85% admitted) 09:00 – 17:00

11. The Tsunami of COPD All these people in hospital are there because there are more people out there, all getting worse We need more beds to cope People come to hospital with COPD after hours

12. What were we trying to change? Patient response – how to stay well Ambulance responses - assess severity by agreed criteria, knowing patient prior status – Call practice if well – Involve Acute Demand / 24 hour surgery if less well – Severe exacerbations or uncertain – ED ED and AMAU responses – consider early supported discharge – ADMS or CREST – Acute Demand nurses in ED and AMAU – Enhance Acute Demand skill to treat COPD Visibility of patient history / plan through technology CCMS & eSCRV

16. Outcomes Count of Acute Admissions ED Attendances (Total and those brought by Ambulance) Occupied bed days % of patients admitted

17. COPD admissions last 105 weeks

18. Bed days last 105 weeks

19. Bed days E65B last 105 weeks

20. E65B Admissions last 105 weeks

21. MonthSeasonKept at Home (Acute Demand) GP24 Hour Surgery EDTotal% In Primary Care JulyWinter243818623019% August7621611620142% Sept11601412821340% October8571811419742% NovSummer2281110214327% Dec32378311628% Jan521410913922% Feb630108112736% COPD Ambulance Numbers (1 st July 2012 – 1 March 2013)

22. Eye Openers……. System Response The numbers! Ambulance Primary Care GP response Lessons Learned…… Education / communication / engagement Keeping it simple What does success look like?

23. Winter of 2013... More of the Same Meetings with Ambulance ramping up Risk stratification / use of Med’s database Joined up response - CREST – hospital and community Additional links with the MDT