Lightbulb innovation: a new model for community nursing

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When Marina Lupari’s trust looked at transforming community care she grew convinced that thousands of pounds could be saved by implementing a whole new model for district nursing in Northern Ireland. She began a research project that was to dominate her work for the next four years.

Establishing need

She systematically reviewed the evidence of the model that saw nurses given extra education and support to work with high-risk older people in their own homes to manage their multiple chronic conditions. The chronic illness case management service (CICM) was established, and 16 full-time nurses were recruited to deliver specialist care for patients with serious respiratory problems, heart failure and diabetic conditions.

The service focuses resources on patients presenting the highest risk of hospitalisation with the most complex problems, Marina explains. ‘The underpinning principle is to proactively manage the patient’s identified risk factors, which prevents deterioration and therefore avoids unplanned hospitalisation. It’s about working out when patients are showing the early signs of being sick and then giving them the tools to help rectify the problem. ’  

Evaluating impact

Marina knew the service was effective but needed to prove it, so she secured funding to conduct a controlled trial. Nearly 600 people took part, with half receiving usual care and the other half the CICM intervention. At four points over a 12-month period, Marina compared differences in outcome for the number of hospital visits, length of stay, health-related quality of life and functionality.

Building on success

The results were positive, with bed days reduced by 59 per cent in the group receiving specialist care. Patients also reported feeling better overall and said support from the CICM allowed them to function better.

Marina also looked at the costs saved. The difference in average cost per patient was £1,493 lower for those who received the CICM service, representing a total saving of more than £400,000 across the nine month follow-up period.

‘This study confirms that if you provide care at the right time, using the right intervention, provided by the right professional you will achieve the most effective and cost-effective outcomes,’ Marina says.’

If you'd like to know more about this innovation, please contact Marina Lupari via the RCN Research and Innovation Team, email: research.innovation@rcn.org.uk.

Marina Lupari's work won the inaugural RCN Frontline First Innovations award 2011.

 

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