Reducing end of life hospital admissions from care homes

Dr Ian Jones, GP, Glyn Ebwy Surgery, Ebbw Vale

Aneurin Bevan University Health Board

Blaenau Gwent West Neighbourhood Care Network (NCN)

Background

Care home patients are usually elderly and more frail than the general population. Between 2018-2020, 833 care home patients died in hospital in the Aneurin Bevan University Health Board area.

We carried out research which found that care home residents are admitted to hospital at end of life for a variety of reasons, including acute admission by GPs, care home staff calling emergency ambulances, family expectation, trauma (usually fractured neck of femur) and symptom control. There is also variation in admissions between individual homes, and between individual groups of professionals.


Our research determined that reducing admissions from care homes at end of life could only be addressed by looking at the individual circumstances of each admission and working across homes and organisations to address any perceived gaps in patient care.

Project Aims


The overall aim of the project is to improve the management of care home patients at end of life. The intention is not to reduce hospital admissions from care homes. Although it is likely, if the project succeeds, that such overall hospital admission rates would fall.


  • All care homes (nursing and residential), and all GP practices in the Blaenau Gwent West NCN will be approached and hopefully recruited into the project,

  • Welsh Ambulance Service Trust (WAST), the Blaenau Gwent local Intermediate Care Team, GP Out of Hours service, and community hospice (Hospice of the Valleys) will also be approached and asked to participate,

  • End of life care home admissions would be analysed to identify the reasons for admission and would be discussed with the homes, GPs, and ancillary organisations to develop a full understanding of the hospital admission,

  • Any perceived gap in care will be identified and addressed to reduce the possibility of the same issues happening again.

Challenges

  • All GP surgeries in Blaenau Gwent West NCN agreed to take part in the project. The 2 nursing homes in the area and 1 residential home also agreed to participate but 1 residential home declined. The 2 remaining residential homes were approached, but Covid-19 restrictions came into force before the homes agreed to join.

  • With Covid-19 restrictions imminent, the project formally came to a standstill in late February 2020. Our GP practice continued to provide supportive care to the 1 nursing home and 1 residential home directly linked to the surgery.

  • This project would certainly fit within the prudent model of health care, but as this approach is not a national or local priority it is sometimes difficult to get senior buy-in at a regional or local level.

  • Covid-19 restrictions stopped this project 12 months ago, and no data is available to determine the project’s success. There is scope to restart the work and I have approached Aneurin Bevan UHB for further funding. As this project is a local initiative, interest in participating is variable amongst those invited to participate and amongst those participating.

  • When setting up the project the aim was to start small and to build up numbers of participating organisations. This is still the case and there is huge scope to improve the care of the frail elderly in care homes.

Next Steps

The project cannot restart until lockdown restrictions are lifted. A Clinical nurse Specialist from our local hospice will carry out case analyses, with the GP lead overseeing the work.


Our neighbouring NCN (Blaenau Gwent East) has around 150 nursing home beds and it would be ideal to incorporate these homes and their linked GP surgeries into the project.


As of January 2021, discussions are taking place on linking this work with the Compassionate Communities model of care currently running across Blaenau Gwent.

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Contact

Ian.jones19@wales.nhs.uk