Spread and adoption
The AHSN Network supports adoption of innovations identified by the Accelerated Access Collaborative and those that the AHSNs identify for national spread.
It also identifies and supports the adoption of innovations on a regional and cross-regional basis.
Case study – Transfer of Care Around Medicines (TCAM)
KSS AHSN is leading the implementation of the TCAM pathway across Kent, Surrey and Sussex.
When some patients leave hospital they can need extra support taking their prescribed medicines. This may be because their medicines have changed, or they need some help to take their medicines safely and effectively.
The transfer of care process between care settings is also associated with an increased risk of harm, with 30-70% of patients experiencing unintentional changes to their treatment, or an error being made because of a miscommunication.
TCAM aims to keep patients safe when they transfer between care settings, providing a seamless transfer of a patient’s medicines information on discharge directly from the hospital to the patient’s choice of community pharmacy.
This is achieved through the safe and secure PharmOutcomes platform, a system already familiar to community pharmacy.
Improving the transfer of information about medicines should help ensure patients continue to take the right medication once at home and reduce the incidence of avoidable harm and readmission.
We are working with partners across Kent, Surrey and Sussex, including trusts, local Pharmaceutical Committees and Clinical Commissioning Groups, to implement the pathway.
Where possible we set up secure electronic interfaces between the hospital IT and community pharmacy systems in order to provide patient medicines information quickly and seamlessly between care settings.
This pathway is now live in East Sussex Healthcare NHS Trust, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Surrey & Borders Partnership NHS Foundation Trust, and Royal Surrey NHS Foundation Trust. Further implementations are planned for 2020/21.
In 2019/20 there were 809 eligible and contactable patients who had an electronic referral to community pharmacy. Of these, 583 patients had a completed follow up with a community pharmacist giving a ‘completion rate’ of 72%. Patients receiving a follow up with a community pharmacist are less likely to require hospital readmissions.
An interim report has been created for East Sussex Healthcare NHS Trust for the first nine months since the ‘go live’ date of 1st April 2019, showing estimated cost savings of c. £68k in total.
465 patients were referred to community pharmacy with 289 receiving a follow up with a community pharmacist (62.2% completion rate). The rate for 30-day readmissions in the followed-up cohort was 15.6% compared to 19.3% for the cohort which did not have a follow up, resulting in 10 ‘saved’ readmissions. The rate for 31-60 day readmissions in the followed up cohort was 5.2% compared to 9.1% for the cohort which did not have a follow up, resulting in 11 ‘saved’ readmissions.
There was also a significant reduction in length of stay for the followed up cohort who then had a 30-day readmission of 3.7 days, saving a total of 264 bed days (138 of these being excess bed days) resulting in a saving of c. £47k.
Case study – Relieving winter pressures – Respiratory
Cold weather can trigger exacerbations for people living with respiratory disease, accounting for many winter hospital admissions and potential patient safety risks.
Our work on the Chronic Obstructive Pulmonary Disease (COPD) Discharge Bundle supports trusts to deliver six high impact interventions to ensure the best clinical outcome for patients admitted with an acute exacerbation of COPD (AECOPD).
The aim of the COPD Discharge Bundle is to reduce the number of patients who are readmitted following discharge after an AECOPD, and to ensure that all aspects of the patients’ COPD care is considered.
In 2019/20, 3,905 patients were recorded onto the COPD national audit as having received at least one measure of the COPD discharge bundle (83% of all live discharges). Using all exclusion criteria available, 11% of patients received all measures they were eligible for and, on average, patients received 54% of the measures they met the criteria for.
An improved discharge process supports patients staying well in the community, as well as supporting self-management (3,202 patients), ‘rescue packs’ (1,167) and referral to Pulmonary Rehab (3,318) and smoking cessation services (806) where appropriate.
Evidence shows that accessing PR improves people’s ability to walk further, and helps them to feel less tired and breathless when carrying out day-to-day activities.
PR has been shown to result in improved quality of life (including higher activity and exercise levels), support better self-management and reduction in exacerbations, reduction in numbers of acute and emergency admissions and reduction in primary care appointments.
KSS AHSN also holds a Respiratory Collaborative event in November each year, to meet and support teams across the region before the winter pressures fully start. The event focuses on quality improvement and reducing variation, as well as providing a peer support environment across the respiratory pathway.
We are also actively supporting the Royal College of Physicians PRSAS scheme, which aims to improve the quality of pulmonary rehabilitation services throughout the UK. Over the course of the financial year, 14 of our region’s 15 PR providers signed up and are participating in the first regional approach towards accreditation.
The NHS Innovation and Technology Payment (ITP) 2019/20 programme supports NHS England’s commitment to accelerate the adoption and spread of proven and affordable innovations, as set out in the Five Year Forward View and NHS Long Term Plan.
The ITP aims to remove financial and procurement barriers to support the NHS to adopt innovative medical devices, diagnostics, and digital products.
As the following case studies show, we’ve been supporting our STPs/ICSs to access the innovations that are relevant to their needs.
Case study – Placental Growth Factor (PlGF)–based testing
Pre-eclampsia (PE) is a multisystem hypertensive disorder of pregnancy that affects approximately 3% of all pregnancies, however to date there has been no definitive test to diagnose PE. The exact cause of the condition is unknown, but it is thought to occur when the placenta becomes dysfunctional or “unwell”, and the only way to cure PE is to deliver the baby.
If the disease is allowed to progress it can result in maternal organ failure and foetal growth restriction and, in some cases, foetal or maternal death. Clinical teams therefore have a high degree of suspicion for the disease and a low threshold to admit pregnant women with suspected PE, placing unnecessary burden on the healthcare system and causing unnecessary anxiety for the woman and her family.
PlGF-based testing can help with clinical risk stratification for women with suspected PE, meaning they can be treated appropriately according to their need, improving both patient experience and outcomes and improving the use of scarce system resources.
Prior to our involvement no KSS sites were using PIGF-based testing. We have now helped to spread the adoption of the test into East Sussex Healthcare NHS Trust, Dartford & Gravesham NHS Trust, and Medway NHS Foundation Trust under the first phase of funding.
We were also able to help secure funding for two further sites to use the test, as part of phase 2 of the AAC pathway transformation (PTF) funding, in Sept/Oct 2019.
Our Maternal Neonatal Collaborative has been kept well informed of the work, and we are working closely with our clinical midwifery KSS AHSN leads to further its use across the region.
Case study – SecurAcath
Patients may experience several complications when peripherally inserted central catheters (PICC) are moved or dislodged at the insertion site. The adhesive dressing are removed during weekly routine dressing changes, leaving the catheter unsecured and at risk of movement and migration, which can lead to adverse patient impacts.
Compared to adhesive securement devices, SecurAcath provides continuous securement from catheter placement and never needs to be changed.
SecurAcath does not require sutures or adhesives. It secures at the insertion site using small, flexible securement feet placed in the subcutaneous tissue below the dermis. This allows for improved site cleaning, less catheter manipulation and eliminates risk of accidental dislodgement or migration during routine dressing changes.
Because SecurAcath lasts the life of the line, this lowers the total cost of patient care by dramatically reducing the complications related to routine adhesive securement changes and sutures.
Many of KSS trusts were already using SecurAcath prior to ITP 2018/19, therefore our activity has focused on initiatives such as supporting successful adoption at the few trusts not already using SecurAcath, maintaining a relationship with the supplier, and ensuring trusts were procuring it at zero cost under the ITP.
Nine out of ten acute KSS Trusts are now using the technology, leading to the supplier describing Kent as a national super-user of SecurAcath.
Case study – HeartFlow
HeartFlow is a personalised cardiac test that performs advanced image analysis to create a 3D model of the coronary arteries and analyse the impact that blockages have on blood flow.
The HeartFlow Analysis utilises data from a patient’s non-invasive coronary CT. Once the data is securely uploaded to the cloud, HeartFlow leverages deep learning and trained technicians to create a personalised, digital 3D model of the patient’s coronary arteries.
The HeartFlow Analysis then uses powerful computer algorithms to simulate blood flow and assess the impact of blockages on coronary blood flow.
This test can help clinicians rapidly diagnose patients with suspected coronary artery disease (CAD) and avoid the need for invasive procedures. This can reduce hospital visits by delivering information to enable a clinician diagnosis through one test.
At the start of the financial year, no trusts in KSS were using HeartFlow. As a result of our concerted efforts to raise awareness of the product and encourage clinical engagement, HeartFlow has now been fully adopted in five trusts across the region.
Two further trusts are in the later stages of adoption, and while the three remaining trusts are not eligible for ITP funding due to too low volume, we continue to keep them updated on the product as they pilot or consider introducing CT coronary angiography (CCTA) services.
Based on the HeartFlow business case model, we anticipate that savings across Sussex would be:
Reduction in angiograms (pa) – 443
Total cost savings (pa) – C£419,000