Falls Webex Wednesday 25th July 2018

1

Agenda

• SAS Updates

– Data

– E –PRF/E-Referral

– SAS App

• Improvement Work - Forth Valley

• Improvement Work – GG&C

• SAS Intensive Improvement – Future

Plans

• Economic Modelling

2

Referrals

3

SAS Data

• Unable to provide reports for patients

who have fallen and not been conveyed

to hospital

• Talks ongoing with software provider

• Solution to be tested before

implementation

• Going Forward

– Reporting Tool

– Regular Reporting

4

E-PRF/E-Referral

• On all SAS vehicles

• Level 1 Screen available to SAS crew

• Completion sporadic

• Impacted by data issues

• Staff awareness of L1

• E-Referral test in Lanarkshire

– Data Sharing

5

SAS App

• Has been tested in one area

• Feedback from staff

– Some errors on App

– Some changes required to

• Changes currently being done

• Definite date for release TBC

• Edinburgh and Fife pathways being

formatted for App

• Is your pathway ready to go on?

6

Going Forward

• Falls Reports

– Review of data provided

• Refining our measures

• SAS Leads will be contact point for falls

data and reporting

• SAS Leads will be supported with Data

Reporting Tool

• Improvement Plan being drafted

• Data to inform Rapid Improvement Work

7

Forth Valley Improvement

Work

Sue Baxter-Wynne

Strategy Implementation & QI Manager

8

Report Out – Forth Valley Falls

Falkirk Station 26th, 27th, 28th March

2018

#sasqi

Project Charter and Team

• Aim – to reduce conveyance to hospital for

the uninjured faller over the age of 65

years in Forth Valley

• Goals – ‘how much by when’ to be defined

by team

• Team Members (5 to 7 people)

– Jane Brown - Spokesperson

– Claire Walker - Recorder

– Ewan Hoggan - Scribe

– Tam Gentles – Time keeper

0

1

2

3

4

5

6

7

Number of Non Dangerous Falls for Patients >65 with a Referral Stop Code Forth Valley

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Average On Scene Time for Forth Valley AILIP Patients >65 which were Referred

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Average On Scene Time for Forth Valley AILIP Patients >65 which were Not Referred

Defining the Problem

• Currently, too many patients >65 years of

age who have had a non dangerous fall,

and who are uninjured are being conveyed

to hospital. Resulting in... – Patients being conveyed when that might not be the best course of

action for them

– Pressure from family to convey to hospital

– Crews are not always confident to leave patients at home

– Quicker to take patient to hospital than to refer

– Crews not always aware of what services there are in locality

Process Mapping

Analyse Cause & Effect

Fishbone Diagram

Test Change Ideas

Driver Diagram

Measurement Plan

Type of Measure Measure

Output Number of referrals

Outcome Improved patient outcomes

Process Initial triage on scene Time on scene Bariatric Alcohol/Drug related Previous falls history Non-conveyed revisited

Structure Inside/Outside fall Number of resources sent Availability of Prof to Prof Skill/crew mix Contactability of referral services (24/7, criteria)

Balancing Patient & Staff Experience Staff confidence

Next steps:

What’s happening in Greater Glasgow

& Clyde?

Ben Watson

Strategy Implementation & Quality

Improvement Manager

20

GG&C Improvement Work

• SAS led session in January 2018

• Standardised Pathway agreed for GGC

– One pathway for GGC

– Helps with cross boundary SAS working

• Monthly Meetings with SAS Leads

• SAS Leads to meet with HSCP Falls

Leads monthly

• Conversations with staff across GGC re

pathway

• SAS crew now referring to pathway 21

GG&C Standard Pathway

22

Pocket Size Pathways

23

Next Steps

• More focussed improvement once

data is available

– Rapid Improvement Workshops

• Raise awareness of L1 screen

– Potential E-referral

– Decision making

– Better data

24

Falls Focus

Selecting Areas of Highest Priority

Webex 25Jul18

Mike Bell

0

10

20

30

40

50

60

70

80

90 89

79

71

60

47

40 36 35

32 32 29 29 28 27 26 25

23 20 18 17 15 14 13 13 13 12 11 11 10

6 5 1 1

Monthly Average Non-conveyed Patients Uninjured Fallers >65 (Jan16 -Oct17)

Referral rate >20% Referral rate <20%

1. Edinburgh City 2. Highland 3. Aberdeen City 4. W. Lothian 5. Moray 6. E. Lothian 7. Midlothian 8. Orkney

1. Glasgow City 2. Fife 3. Lanarkshire 4. Aberdeenshire 5. Forth Valley 6. Renfrewshire 7. Borders 8. N. Ayrshire 9. Dundee City

1. Argyll & Bute 2. Perth & Kinross 3. Dumfries & Galloway 4. Angus 5. S. Ayrshire 6. Inverclyde 7. E. Ayrshire 8. W. Dunbartonshire 9. E. Dunbartonshire 10. E. Renfrewshire

Do More of the Same Priority Wait and Learn

Questions?

31

SAS Falls & Frailty Community

Pathways

Economic Model

Overview

Wednesday 25th July 2018

Mark Hamilton & Ann Murray: Active & Independent Living Programme, SGHD

Purpose

The purpose of the Economic

Model is to inform the Health &

Social Care Partnerships

(HSCPs), Scottish Ambulance

Service (SAS) and Scottish

Government about the cost

consequences of implementing

SAS Falls and Frailty Pathways.

Audience

Primary audience:

• Local SAS and HSCP managers, responsible for developing Falls & Frailty Community Pathways;

• Senior managers from HSCPs and SAS regions responsible for making the pathways a success as Executive Sponsors.

Other interested parties are the following who jointly commissioned the development of the pathways:

• Chief Health Professions Officer of Scottish Government;

• Chief Executive of the Scottish Ambulance Service;

• Chief Officers of the HSCPs.

Requirements

Provide information about both the historic and the potential future costs of providing care to people who have fallen;

• Calculate the direct system costs that arise when people fall and call an ambulance for assistance;

• Allow these costs to be shown either for all of Scotland or for a specific Health & Social Care Partnership area;

• Allow comparison to a future system state where care is organised differently.

Be created in such as way as to be easily accessible & usable by local project managers.

Data Sources

• Financial year 2016/17 Crew attendance data (SAS).

• Financial year 2016/17 A&E Attendance Data (ISD)

• Financial year 2016/17 Hospital Admissions Data(ISD)

• Costs incurred for all admissions based upon actual length of stay of each patient (ISD).

ISD: Information and Statistics Division of NHS National Services Scotland

SAS: Strategy Implementation and Quality Improvement team of the Scottish Ambulance Service

Assumptions

• 2016/17 was a typical year for falls activity.

• There was negligible referral activity during

the sample period.

• The overall number of falls will rise as the

number of people aged 65+ increases.

• Costs reduced or avoided are not likely to be

retrieved as efficiency savings, the aim of

the economic model is to demonstrate that

greater use of community rehabilitation will

mitigate against future cost increases.

The Model

• Logical flow used as the basis for calculations and for

visual presentation of the statistics

• Referral rate, conveyance rate and cost per referral can

be set and modelled by the user.

• SAS & Hospital Falls Activity for 2016/17 as a Base.

• Cost per Admission is a real, evidenced cost, calculated

from the actual Length of Stay of the individual patients

who fell, called SAS, were conveyed & assessed in ED

and then admitted.

• Cost per Conveyance / Non-Conveyance is an average

cost for Scotland.

Example – Glasgow City

SAS Attended Falls Activity 2016/17

• Number of Fallers 4531

• Conveyance Rate 75.6%

• Referral Rate 0.0%

• Admission Rate 66.8% Note: Admission Rate is relative rate, i.e. 66.8% of the 75.6% conveyed to

hospital were admitted, which is an absolute admission rate of 50.5% of falls attended.

Attended Falls Costs 2016/17 – Individual Patient

• £ per Conveyance £326

• £ per Non-Conveyance £252

• £ per ED visit £123

• £ per Admission £11,298 Note: ED costing to be revised upwards. Figure shown is all comers

average cost.

Example Analysis Glasgow City Health & Social Care Partnership

Glasgow City SAS Attended Falls Statistics 2016/17 – All Attended

Patients

Modelled System is one where Referrals are at 50% of non-conveyed

patients and conveyance is reduced from 75.6% to 72%

Note 1: Whole System Cost is total for all patients, conveyed, non-conveyed, ED, admission

and stay.

Note 2: Cost Per Fall is simply Whole System Cost divided by the total number of falls

attended by SAS.

Note 3: For the purposes of the model it is assumed that there were in effect no referrals of

Example Analysis Glasgow City Health & Social Care Partnership

Glasgow City SAS Attended Falls Statistics 2016/17 – All Attended

Patients

Modelled System is one where Referrals are at 50% of non-conveyed

patients and conveyance is reduced from 75.6% to 72%

Note 1: Whole System Cost is total for all patients, conveyed, non-conveyed, ED, admission

and stay.

Note 2: Cost Per Fall is simply Whole System Cost divided by the total number of falls

attended by SAS.

Note 3: For the purposes of the model it is assumed that there were in effect no referrals of

THANK YOU

Any questions or

comments?