Leads:
Dr Sarah Damery, Dr Janet Jones, Prof Kate Jolly (Long-Term Conditions)
Dates:
01/01/2023 to 31/03/2023
Background:
In recent years, there has been a growing recognition of the need to identify and manage resident deterioration in the care home setting in order to minimise A&E attendances and reduce hospital admissions. Care home staff are ideally placed to notice the ‘soft signs’ of deterioration, but they may lack the skills to act on what they see, and there is often a lack of pathways through which resident care can be escalated. In the West Midlands, the Academic Health Sciences Network (AHSN) was responsible for implementing the national Managing Deterioration Safety Improvement Programme (ManDetSIP), which aimed to increase the safety of care home residents through the adoption and spread of deterioration management tools by care homes, and through working with multiple system partners across health and social care. NIHR ARC West Midlands carried out a rapid evaluation of the delivery and effectiveness of ManDetSIP in care homes across the region.
Policy and Practice Partners:
West Midlands Academic Health Sciences Network.
Co-Funding partners:
Funded by West Midlands Academic Health Sciences Network.
Aims and Objectives:
The evaluation aimed to describe the implementation of ManDetSIP across the West Midlands and to evaluate its effectiveness in terms of the rollout and adoption of deterioration management tools in care homes, and in key outcomes relating to rates of 999 emergency calls, ambulance calls, hospital admissions and length of hospital stay by care home residents. This was intended to provide the AHSN with an independent evaluation of their impact within the region, to feed in to national decision-making about deterioration management, and to act as scoping work to establish the feasibility of a larger piece of work on deterioration management in care homes.
Methods:
As this was a rapid (three month) piece of work, the evaluation assessed experiences of the deterioration management programme, learning from implementation, and processes of implementation, from five key informant interviews with individuals from the AHSN directly involved in the programme design and delivery. Other outcomes and a ‘mapping’ of the programme were derived from a review of secondary sources (documents, resources, case studies, testimonials and quantitative data) collected by the AHSN.
Main Results:
Data showed that the West Midlands approach to implementing the national ManDetSIP was highly effective and demonstrates a best practice example of effective programme rollout. A number of effective programme features were identified:
- The engagement of multiple stakeholders in the programme across health and social care at the macro scale (whole region), meso-scale (six Integrated Care Systems (ICS)), and micro scale (the individual care home).
- The establishment of deterioration networks in each regional ICS.
- A regional deterioration patient safety network.
- Development of effective training webinars for care home and primary care staff.
- Development of localised resource packs and escalation pathways.
- In-depth data collection to monitor trends in outcomes over time.
- Development of a care home patient safety network to act as a training space for care homes.
- The incorporation of sustainability planning into each ICS’s rollout of deterioration management tools and pathways within their local area.
Overall, there was a 1% reduction in 999 calls from care homes across the region, a 4% reduction in emergency hospital admissions, and a 5% reduction in the length of hospital stay.
Conclusions:
The AHSN’s implementation and rollout of the managing deterioration programme across the West Midlands was highly effective in supporting care homes to identify and escalate concerns about deterioration of residents within their care.
Implications for Implementation:
The implementation of ManDetSIP was very successful. Future work should assess the longer-term sustainability of implementation, adoption and spread to understand how well the changes are embedded regionally over time.
Protocol:
N/A
Publication:
N/A