What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

In East Lancashire, NWAS refer adults with sub-acute/intermediate care to East Lancashire Integrated Care Assessment Team (ICAT). Referrals are predominantly older people. Referrals are made for patients who are experiencing a deterioration in their health or care needs such as falls, chest infections, urine infections, cellulitis, heart failure and pain.  During the April 2020 COVID peak, NWAS clinicians supported 35.5% of patients in East Lancashire to stay at home following a face-to-face assessment (See & Treat), 35 of these patients were referred to ICAT. NWAS See & Treat in East Lancashire dropped to 28.6% in September 2020 and ICAT referrals are 25 per month, on average.  ICAT have created a COVID Virtual Ward which aims to provide rapid, initial remote assessment of COVID positive patients to support their management at home. ICAT are working with NWAS both to increase the number of referrals made by improving clinician decision-making confidence to conduct an initial remote assessment.

What does your project aim to achieve?

The project aims to develop and test digitally-enabled information sharing between NWAS clinicans and East Lancashire ICAT to support the ICAT virtual assessment of patients. Information is currently shared between the organisations via telephone with handwritten paperwork.  Digitalising part of the process aims to enhance the quality of information shared and support confidence in virtual assessment of patients because a written record of a full face-to-face clinical assessment will be readily available. The project will explore how technology can support a joined up assessment. The aim is to increase the number of patients that NWAS refers to ICAT, thereby reducing the number of patients conveyed to a hospital setting and enable rapid community intervention. ICAT also hope to increase the number of patients that they are able to assess remotely which will reduce close contact, benefitting both the patient and NHS clinician by supporting safer assessments during the COVID pandemic.

How will the project be delivered?

Delivery will involve collaboration between NWAS Quality Improvement, Digital Innovation, Informatics teams and the East Lancashire ICAT. Specialist software development expertise will be purchased and our plan is to facilitate face-to-face or virtual design workshops to agree an information sharing platform. We aim to achieve a digital electronic information sharing process which will be compliant with Data Protection Impact Assessments (DPIA) and the Interoperability Tool Kit (ITK). Once created, we would then perform small scale testing with a limited number of NWAS clinicians with periodic evaluation and adaptation. Impact will be measured through referral numbers, admission avoidance rates and monitoring of patient outcome. The data sharing risks would be managed through the DPIA and ITK. The project will provide testing and evaluation on a small scale to create a minimum viable product that can then be scaled up across the area with potential for regional adoption.

How is your project going to share learning?

External

Learning and progress throughout the project will be shared via Twitter and Facebook. The project team will actively participate in Q Exchange and Q Community activities and events. A written evaluation will be provided at the end of the project to summarise methodology, measurements and learning.

Internal (NWAS)

This work links into existing programmes of work to reduce avoidable conveyance to hospital and increase community referral pathways. NWAS is currently recruiting to an evaluation post, based within the Quality Directorate. This role could design a simple evaluation framework that could run alongside this project. There is an ongoing improvement programme ‘Treat Half at Home’, supported by an active Improvement Network, which aims to increase clinician confidence making decisions not to convey patients. Learning from this project will be shared internally within the Improvement Network and as part of Treat Half at Home.