Transcript Frequent Attenders - NHS Gloucestershire CCG

Frequent
Attender Nurse
and Pilot Study
Jim Welch, RMN.
Mental Health Liaison
Manager, 2gether.
Background:
There is little guidance on the management of this patient
group and little published.
 “The College of Emergency Medicine, Best Practice
Guideline” (2014) Literature tells us that
“Frequent users of other services GP and Ambulance,
vulnerable are at high risk of morbidity. There is excessive use
of services whilst in crisis however this frequency will drop”
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Bespoke plans DO NOT reduce attendances to the
department
But they ensure “safer care” They give a safer
analgesia strategy (helps with drug seeking behaviours),
patient involvement and collaboration formulating the plans
also helps with adherence.
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So where to start cont…
The document outlines what and how the plans
should be formulated by MDT. Assessment should be
conducted by a senior clinician and provide clear
guidance on:
 Who should see the person.
 Reducing any unnecessary tests.
 Ensuring consistency of care.
 Summarising and defining historical and current
risks.
 Supporting the person whilst in A&E including any
special measures or contacts.
 Recognising the challenges with engagement.
Identifying the patients
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Criteria is 10 x in 12 months or 5 x in 3 months
Use of a “Tracker” (Spreadsheet, Data from
Hospitals IT) amalgamated with information
from Rio.
Identify “Mental Health” Frequent Attenders, on
a monthly basis through data and also “word of
mouth”
Assess Patients within the hospital setting,
reaching a decision that promotes a safe and
supportive discharge. Whilst acknowledging
lifestyle choices and impulsive behaviours that
may lead to significant adverse outcomes.
Frequent Attender Manager
Role:
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Patients within the “Frequent Attender Programme” are
high intensity/complex individuals with multiple issues
and needs,
Follow up appointments with patients and where
possible Lead Professionals/Care Co-ordinators.
Outreach work - visiting patients at their homes, using
an holistic approach to aid engagement with services
that meet their needs,
Evaluating patient experiences and finding alternative
solution’s,
Frequent Attender Manager
Role:
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Close working with unscheduled care (A&E, ACU)
Co-working with 2Gether services (MHLT, Recovery, AOT).
Close working relations with SWAST - Frequent Attender
Paramedic.
Contacts within Turning Point – to be further developed.
Close working relationships with Police,
Liaising with GPs, sharing information, formulating plans,
Interface with the Pain Management Team, using their
specialist knowledge and advice within the plans i.e.
Patients with drug seeking behaviour,
Plans are developed with the patient outside of the “crisis”
Frequent Attender Manager
Role:
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Co-ordinating and participating in Professionals
meetings.
Co-writing care plans with clear concise
boundaries which manage patients whilst in the
Emergency Department or hospital setting.
Clear signposting for discharge (avoids delays
whilst managing risk and supporting the patient).
Provide continuity with “Frequent Attender
Patients” whilst in the department and afterwards.
Monitoring of contact and reason for contact.
Improving staff awarenessand morale.
Case Vignette:
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Patient ZW, Drug seeking behaviour at A&E and
SWAST,
2014 - 49 x attendances, Admitted 29x
2015 - 51 x attendances, 18x admitted,
June – plan developed 1 x admission to date.
Plan highlights professionals involved and advice for
pain relief (given from Pain Management Team) it
has reduced regular Opiates, given by Ambulance
service, A&E and on the wards and alternatives are
reinforced.
Future Developments:
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It would appear that this role Does NOT reduce
attendances. However it manages the patient in a
consistent way.
It would appear that it reduces the need for, or
length of, admission by providing a clear
discharge plan.
Develop Early Intervention: diverting/signposting to
services outside of A&E breaking cycle of
attendance.
Improve IT systems to capture Mental Health
related presentations with greater reliability (in
progress).
Future Developments:
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Clear referral pathway, at present ad hoc from
clinicians.
Continue to build positive relationships between
services, providing a positive interface.
Closer working relations with 111,
Closer working relations with Turning point,
Co work with GHNHSFT frequent attender
manager (newly appointed).