Lightbulb innovation: supported discharge and admission avoidance for people with Chronic Obstructive Pulmonary Disease (COPD)

Image of a lightbulb with the words lightbulb innovations

Improving the quality of life for patients with complex healthcare problems, such as chronic obstructive pulmonary disease (COPD) has been just one of the many benefits realised by the introduction of an integrated respiratory service in the community, led by Alison Graham.
 
The team development at Central and Eastern Cheshire PCT (CECPCT) was the result of a major review and service redesign to minimise hospital stay and promote effective management in the community of patients with respiratory diseases such as COPD. The planning phase was extensive and involved a group of cross-sector stakeholders including clinicians from the 2 acute hospitals (doctors & specialist nurses/physiotherapists), GP's, practice nurses, allied health care professionals, commissioners, and, providers and managers of services.
 
Prior to integration there was inequity in service provision across the localities, high admission rates, long lengths of stay, no specialist community clinic provision and limited care at home available for the respiratory patients and their carers. The oxygen prescribing costs for the locality was high at £1,000,000 per annum.
 
The integrated respiratory team (IRT) now provides an in-reach and out reach specialist respiratory service for patients with COPD and other lung diseases in Central and East Cheshire. The IRT offers a 7 day service which incorporates acute hospital care, same day & early discharge services for patients with COPD, patient assessment and support within their place of residence to facilitate hospital admission avoidance,  community & hospital based specialist nurse led clinics, a patient oxygen assessment service, pulmonary rehabilitation and palliative care. In addition the IRT supports the provision of respiratory education within CECPCT and acts as resource for other health care professionals. The team consists of 14 nurses and 2 physiotherapists.
 
Alison is delighted with the positive outcomes with the newly integrated service. "Not only has there been an improvement in patient experiences and clinical treatment" she says, "but we have also been able to demonstrate significant financial savings for the Trust, in terms of reduced hospital admissions, reduced length of stay in hospital, and reduced oxygen usage and costs". The estimated saving in oxygen prescribing costs was in excess of £200,000 within the first 2 years.  There are high levels of patient satisfaction with the service, particularly as the patient spends more time being supported at home, can understand and help to manage their condition, and they spend less time in hospital or in the hospital out patient setting. Referring clinicians are reassured that their patients are receiving the right advice and support. "Like all change" recalls Alison, "when we first set out, there was some resistance, and we had to work hard to demonstrate the potential long term benefits; but now pride ourselves on the excellent working relationships there are between the hospital and community interface and between general practitioners and the respiratory team".

Further information

The Office for Public Management have used this work as a case study to demonstrate return on investment. How managing oxygen therapy in the community can save up to £1.1m per annum and improve quality of life for patients (PDF, 79KB).

If you'd like to know more about this innovation, please contact Alison Graham, email: a.graham2@nhs.net

 

If you liked that, you might like this