Atrial fibrillation (AF) is the most common cause of an irregular heart rhythm and the cause of 20% of strokes. Despite the serious impact, many people are unaware they have the condition.
Since 2017, the AHSN Network has been driving the spread and adoption of AF best practice across the country to improve care and outcomes for patients. This national programme of work has focussed on the three key elements of the AF pathway:
- Detect – raising public awareness of AF and the importance of pulse rhythm testing to identify those with undiagnosed AF.
- Protect – supporting healthcare professionals to offer optimal anticoagulation medication to all those who would benefit
- Perfect – supporting patients with their anticoagulation medication and supporting clinicians to review patients with AF.
Pulse checks for over 65s, mobile ECG devices for GP surgeries and pharmacies, and new ‘virtual clinics’ involving specialists working with GPs to advise on the best treatment for people with the condition have been amongst the varied activities undertaken as part of this life saving work across the country.
In 2018/19, 3,648 people with AF in the West received anticoagulants, potentially preventing 146 strokes and avoiding costs of nearly £2 million to the NHS.
Emergency Laparotomy Collaborative
Emergency laparotomy is a major surgical procedure on the abdomen, with 30,000 to 50,000 performed every year in the UK. However around 15% of patients are reported to die within 30 days of surgery. Over a quarter of patients remain in hospital for more than 20 days after surgery, costing the NHS over £200 million a year.
Funded by the Health Foundation, the Emergency Laparotomy Collaborative was formed in 2015 (with West of England AHSN as a founding member) to use a quality improvement approach to tackle these issues. This approach is now being used by all 15 AHSNs working with their local hospital trusts.
To date 5,091 patients in the West have benefited from the work of the Emergency Laparotomy Collaborative.
Chronic joint pain, or osteoarthritis, affects one in five people over the age of 50, and one in two people over the age of 80 in the UK. This condition can cause considerable suffering and distress, and can reduce quality of life.
A small proportion (about 5% of the eight to ten million sufferers in the UK) proceed to surgical intervention. However, the vast majority are managed in the community, usually with painkillers – which are both unpopular with patients, and potentially harmful. Roughly one in four GP appointments are estimated to be related to joint pain.
ESCAPE-pain is a rehabilitation programme for people with chronic joint pain of the knees and hips, providing self-management support in the community. The course is delivered by a physiotherapist or an exercise professional in 10 to 12 sessions over five to six weeks.
1,243 people with chronic joint or hip pain have participated in ESCAPE-pain in the West of England since 2018.
PINCER – preventing prescribing errors
Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect one in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.
Our PINCER intervention is led by primary care pharmacists and pharmacy technicians. It involves searching GP clinical systems using computerised prescribing safety indicators to identify patients at risk from their medications and then taking acting to correct them.
176 GP practices are engaging in PINCER in the West of England, while 522 patients in the region are less likely to require acute episodes of care due to the medicines they are taking as a result of the programme.
The PReCePT programme was born in the West of England and is now being delivered in all maternity hospitals across the country.
We are working with the neonatal community to increase use of magnesium sulphate to prevent cerebral palsy in very premature babies. (Read our story on how we are achieveing Impact to find out mnore)
Serenity Integrated Mentoring
Across the UK, emergency and healthcare services respond every minute to people in mental health crisis. Mental health crisis calls are increasing consistently each year.
But there is also ‘a problem within this problem’ because in every community, up to 40% of this demand is caused by the same patients: a small number of repeat callers who struggle to manage highly complex behavioural disorders and who, as a result place intensive operational demands on police, ambulance, A&E departments and mental health teams.
Serenity Integrated Mentoring (SIM) is an innovative mental health workforce model that brings together the police and community mental health services in order to better support people with complex mental health needs.
The Gloucestershire High Intensity Network saved £10,000 in 10 months through working on the SIM model with Gloucestershire Health and Care.
Transfer of Care Around Medicines (TCAM)
We are supporting patients who need extra support with prescribed medicines when they leave hospital. 30-70% of patients experience unintentional changes to their treatment or an error is made because of a miscommunication.
TCAM is a means of communication between acute trusts and dispensing chemists. When patients discharged from hospital are identified as needing extra support, they are referred through a safe and secure digital platform for advice from their local community pharmacist.
11,710 patients in the West of England have been referred through TCAM since 2018 and over £17 million of costs have been avoided by our CCGs and trusts as a result of the programme to date.