Sussex partnership NHS trust: winner, hospital admissions award

Dr Lisa Page says the way the trust uses mental health triage nurses is unique. Photograph: Sussex Partnership NHS Trust

A year ago people with mental health problems turning up at A&E in Brighton often had to wait four hours to be seen. Around 12% of patients would get fed up waiting and leave; those who were prepared to sit it out frequently ended up being inappropriately admitted to the hospital's observation ward, where they stayed until being assessed by the specialist mental health team.

But today, the number of patients with mental health problems being admitted to the observation ward at the Royal Sussex county hospital through A&E has dropped by 50%. More than 85% of patients are seen and assessed by the mental health team within four hours. Anybody turning up and A&E with a mental health problem is automatically referred to a specialist mental health triage nurse within an hour – something which Dr Lisa Page, consultant in liaison psychiatry at Sussex partnership NHS trust, says is unique. "I don't know of any other hospital which uses the triage nurse in the way that we do, although others do have proactive teams in A&E."

The improvement in waiting times and the introduction of the mental health triage nurse is part of the Brighton Urgent Response Service (Burs), which was introduced in January to tackle the 30% year-on-year rise in unscheduled mental health attendances at the East Sussex seaside town's A&E.

Page says the reduction in observation ward admissions is good news for patients and A&E staff but also for the clinical commissioning group (CCG) because of the high tariff associated with this kind of admission. "That is where the savings are coming from as we are no longer having that large number of patients admitted," she says.

Burs, set up by Sussex partnership NHS trust in collaboration with Brighton CCG and the acute trust, also includes a 24-hour urgent phone line for GPs, mental health patients and carers who are new to the system. GPs can book a patient a next-day appointment at the mental health clinic – rather than the previous minimum five-day referral. Patients and carers are offered telephone advice from a Burs practitioner and are referred as necessary. A dedicated mental health nurse is also available in the community between 8am and 8pm Monday to Friday and from 8am to 6pm at weekends. A new waiting room for people with mental health problems, which provides a calm and quiet environment has also been established at the Royal Sussex as part of the scheme.

Page says her mental health team is busier than ever and that it is too soon to say whether the number of people turning up at A&E has pulled back from its 30% year-on-year rise. But she feels Burs is ensuring that people are seen more appropriately and more quickly. She says: "Referrals to our team have gone up by a third because we are now seeing people who in the past would have come to A&E and left. We haven't curtailed the 30% but we have made some inroads – it would have been even busier without Burs."

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Portsmouth hospitals NHS trust: hospital admissions award runner-up

An initiative by the diabetes inpatient team has cut hypoglycaemic episode admissions by nearly 20%. Photograph: Portsmouth hospitals NHS trust

A hospital has seen a 33% drop in the number of diabetes patients calling 999 or turning up at A&E following a hypoglycaemic episode, while admissions fell by nearly 20% following an initiative that helps patients manage their care better and educates GPs about best practice.

The diabetes inpatient team at Portsmouth hospitals NHS trust wanted to tackle the recurring number of diabetes patients being admitted to hospital following a hypoglycaemic event.

It decided that a diabetes consultant and specialist nurse would visit every GP practice in the district twice a year to discuss diabetes management and spread best practice. Educational events were also held at local nursing and residential homes to help improve diabetes management.

A new telephone hotline was set up with South Central Ambulance Service for paramedics to call the hospital inpatient team if they had treated a hypoglycaemic patient. That patient would then be contacted by the team within 24 hours.

Any diabetic patient admitted to hospital following a hypoglycaemic event was given advice about managing their care to prevent another attack.

After the project was launched, the number of hypoglycaemic people arriving at A&E or being seen by a paramedic between November 2011 and November 2012 was 83 – a drop of 33% compared to the previous 12 months. During the same period the number of hospital admissions fell by nearly 20% from 85 to 63.

Dr Partha Kar, the trust's diabetes clinical director, says: "As far as we are aware our pathway is the first to show discernible benefits of hypoglycaemic admissions thereby showcasing how a simple innovative approach can help patient care. The pathway can achieve little unless dovetailed with educational support for primary care which has formed the crux of the local model of diabetes care."

The initiative is part of the trust's Super Six Diabetes model of care designed to move more care away from hospital into the community.

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NHS South Worcestershire CCG: hospital admissions award runner-up

Dr Nikki Burger says the target is for GPs to deal with an average of five ambulance cases a day. Photograph: South Worcestershire CCG

GPs have been dealing with 999 calls during the day, which were traditionally handled by ambulance crews – reducing the number of patients admitted to hospital and saving £1.1m

The scheme was set up by South Worcestershire clinical commissioning group (CCG) and the West Midlands ambulance service last October in an attempt to cut the number of avoidable hospital admissions and free up paramedics to take on more life-threatening calls.

GPs are available from 12pm until 8pm – when 999 calls are often at their highest – every day of the week.

An ambulance is always dispatched to the scene in case an emergency admission is needed. But the crew or the ambulance control room can call out the GP if it is felt that the patient could be treated at home by the family doctor rather than being taken to hospital.

Since the scheme was launched last October 50 GPs have taken 1,221 calls with only 20% of patients being taken on to hospital. The project, which costs £21,000 a month to run, has prevented 970 A&E attendances and 500 hospital admissions, saving £1.1m. The scheme has been so successful that GP urgent support is also being made available to care homes, minor injury units and community care teams.

GP Dr Nikki Burger, the CCG's urgent care lead, says: "We recognised the potential to expand the role. Our target is that the GP deals with 35 ambulance cases a week – an average of five a day – and the rest of the time they are available to provide the extended support role."

The initiative was originally run as a pilot scheme by the CCG's predecessor Worcestershire primary care trust as a solution to tackling increased demand on NHS services during the winter.

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