Service evaluation for a New Urgent Care Service

Problem

In 2011/12, NHS Corby was within the worst 10% of all CCGs for A&E utilisation with the number of patients admitted for less than 24 hours costing £1.3m annually. Local clinicians set out a business plan for the construction of a community-based urgent care centre to manage patients in the community more effectively, streamline services and improve cost effectiveness.

Approach

From its inception, the UCC has used a GP-led triage system to optimise early decision making. Point of care testing includes troponin, D-dimer and blood gas analysis in addition to routine blood tests, ECGs and radiology. It also has three four-bedded observation bays where patients can be observed and receive treatment before being discharged or referred for further care. Data has been collected for all these activities and we are have been analysing this to look at outcomes in terms of patients seen and treated. We have also carried out a patient satisfaction questionnaire over a 4 weeks period at all times when the centre is open (8am to 8pm 7 days a week).

Findings

After its opening in October 2012, there was a decrease in the number of Corby residents attending the local A&E. This trend continued further when the X-ray facility opened in February 2013. This is in contrast to the trend in national A&E attendance data, which has shown no such decrease over the same period of time. Attendance has increased annually since opening, with an average of nearly 60,000 patients seen each year and similar patterns and seasonal peaks to those seen at the local A&E. Over a quarter of patients seen are paediatric (majority aged 0-5 years). Over time the proportion of patients requiring follow up from their own GP has steadily decreased and only 1% of patients are onward referred to A&E. Five triage categories are applied (immediate, very urgent, urgent, standard and non-urgent); the majority of patients are triaged as Category 4 (standard). Those triaged as Category 3 and above constitute patients that would traditionally need to attend A&E, even if seen by a GP first: Corby data demonstrates success in avoiding A&E attendance for 76% of these patients (for paediatric patients the equivalent avoidance figure was over 80%). Initial analysis of the patient satisfaction data shows that patients were highly satisfied with the service that they received with positive responses of an average of 96.7% were received for the main 10 questions asked.

Consequences

Initial data analysis from the UCC confirms patient demographics and demonstrates the effect that its particular approach (model, recruiting, training, pathways, SOPs, near patient diagnostics) has had in minimising local A&E attendances. Patient satisfaction analysis also indicates overwhelming user positive feedback for this innovative model of urgent care delivery.