Project Summary

The aim of this project is to simply bring about a real change within care homes; through the introduction of a skill package to provide subcutaneous fluid training within care homes. Once implemented this will produce quickly identified benefits, improve standards and promote good practice, whilst ensuring better outcomes for patients at a reduced cost.

Many admissions into hospital from care homes are proven to be preventable and are often to rehydrate clients, particularly elderly clients with dementia.
• Drive quality clinical care
• Shift focus to early intervention, treatment and prevention
• Develop service provision

The problem

Demographic trends report that the fastest growing age group throughout the population is the over 85 year olds. With this in mind the future excellence of nursing care provision is critical. Placements to nursing homes will increase, putting more pressure on resources. It is therefore imperative that there are early interventions to minimise national costs.

Elderly patient’s prolonged stay puts them at risk from further infection (25% of over 85 year olds contract additional infections).

Information collated from Kettering General Hospital for the period of January 2011 to September 2011, (nine month period), indicates:
• There were a total 757 discharges into nursing homes from Kettering General Hospital. (3.9% of all admissions).
• 656 patients that stayed overnight in KGH were nursing home residents
• Nursing home residents used a total of 10,216 bed days
• 9.3% of all bed days were used by nursing home residents
• The average length of stay in hospital for a nursing home resident was 15.6 bed days. (The general average is 7 to 10 days).

It must also be noted that many admissions from care homes will include clients that have a mental health illness, such as dementia. As we are all aware clients that have dementia do not manage very well in unfamiliar environment and this may present as illness or make illness difficult to treat hence a further increase to length of stay.

Costs incurred when a nursing home patient is admitted to hospital are substantial, approximately 6 million pounds for 2010/11. Where a resident is admitted to hospital, NHSN continue to fund the care home placement for 28 days to a cost in excess of £800 per week, (for some cases £2000 - £3000). Consequently, the true cost of an avoidable admission is the cost of hospital care plus the cost of the nursing home placement.

Proposed education intervention

It is intended to improve outcomes for patients, by educating care staff with the skills and confidence to deliver sub cut fluids appropriately to ensure that early intervention prevents avoidable admission to the acute hospital.

Benefit to Patients

Patients retain dignity and cared for within the community setting of ‘their own home’. Patients will be able to receive early intervention from carers that they are familiar with and who know their needs and abilities.

The risk of risk of further infection is reduced as the patient remains at home; as a consequence they are able to retain routine and familiar surroundings. Reduced risk of falls and loss of mobility.

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Benefits to service

The service will benefit as there will be fewer avoidable admissions. Bed days will reduce as care homes are slow to reassess clients once fit for discharge.

Productivity and impact

On assumed average cost of an admission = £4000, and an anticipated cost avoidance based on 10% reduction (total of 23) in avoidable admissions: £4000 x 23= £ 92,000

On assumed cost of a delayed discharge = £231, and an anticipated cost avoidance based on 5% reduction (total of 250) in delayed discharge: £231 x 250 = £57,750

Total Cost Avoidance
“Patients retain dignity and cared for within the community setting of ‘their own home’.”
“Costs incurred when a nursing home patient is admitted to hospital are substantial, approximately 6 million pounds for 2010/11.”

Project Leads

Gabriella O’Keeffe
Senior Quality Improvement Manager
Quality Directorate
NHS Nene and NHS Corby Clinical Commissioning Groups

Email: gabriella.o’

Phone: 01604 651252

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