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CICSS

CICSS. Crisis Intervention Community Support Service Tony Marsh. What is the issue?. Financial Context – non-elective spend Hospital can be bad for you Intermediate Care Step Up beds Reasons for admission in frail elderly Significant physical illness Social vulnerability

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CICSS

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  1. CICSS Crisis Intervention Community Support Service Tony Marsh

  2. What is the issue? • Financial Context – non-elective spend • Hospital can be bad for you • Intermediate Care Step Up beds • Reasons for admission in frail elderly • Significant physical illness • Social vulnerability • Clinical uncertainty/need for observation • Social Services response • Gedling Action Team

  3. Who Are We? • 21 practices • 133,000 patients • Practice Forum • Executive Board • Emergency Care Task and Finish Group • Part of Greater Nottingham Health Community but Notts County PCT

  4. Why CICCS? • British Red Cross already supporting ED discharges: “Home From Hospital” • Social support model – not clinical • Excellent contacts/signposting ability • Service design a two-way process with bilateral input between commissioner and provider • Run as a pilot initially

  5. Service Model • Rapid response service providing low level intensive care over a short period and ensuring a longer term outcome • Patients can be seen within 1 hour of receipt of a referral • Patients are seen for a maximum of 4 weeks • Care addresses: • Emergency Hygiene Needs • Nutritional Needs • Emotional Needs • Activities of Daily Living • Medication Prompts • General Well-Being

  6. Service Model One Simple Telephone Call “Make it easy to do the right thing” Hours of Service Monday to Friday 7:00AM to 11:00PM Saturday & Sunday 8:00AM to 12:00PM and 5:00 to 10:00 PM

  7. Overview of Service to end Feb. • 289 Referrals Accepted • Referrals have been received from all Practices within the cluster • Number of daily visits per referral – 1 to 4/day • Expanded the service: • Referrals into and out of existing Intermediate Care Service • Medication Reviews by Practice Pharmacy team • B3/D57, acute medical admission unit at QMC • Falls assessment By CICCS Community Workers

  8. Cost • Cost of Service = £151,000 p.a. • Average cost/patient referral = £320.00 • Average cost/episode of care = £6.00 • Average cost for non-elective admission minimum £2,400 • BUT how many admissions avoided?

  9. Benefits & Evaluation • Estimated avoided hospital admissions = 45% of Referrals: (based on asking the referrer) • Estimated cost savings of approximately £453,000 (based on above) • Evaluation: • Patient & referrer feedback • Hospital Admissions pre & post x 12 months • A&E attendances • Falls Prevention • Whole Systems Analysis • Outcomes

  10. Service Outcomes

  11. The Future • Evaluation • Roll out? • Using “the Third Sector” • Flexibility in service delivery, • “Can do” attitude • Unhampered by red tape and bureaucracy. • Something that they can’t do, they’ll find someone who can.  • A well respected charity opens many doors. The British Red Cross has a wealth of knowledge of the number of agencies and services offered in the community, • The organisation is noted for being reliable, trustworthy and non threatening by patients. • An example of the charity’s commitment was during the recent bad weather. • Excellent feedback to GP

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