COPD Management News and Views

By Julie Ricketts, Lead Nurse, Leatherhead Community Assessment Hospital

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common respiratory conditions of adults in the developed world. Encompassing chronic bronchitis and emphysema, this debilitating condition affects approximately 1.4 per cent of the UK population and is the country’s fifth biggest killer.

While many COPD sufferers are kept under close surveillance, some unfortunately still remain at high risk of emergency admissions – which can be costly to Primary Care Trusts (PCTs) from both a financial and a patient care perspective.

With the number of COPD case loads expected to rise over the coming years, improving the level of care for patients, avoiding related emergency admissions and keeping costs under control, are all high priorities – something the team at Central Surrey Health realised several years ago. Julie Ricketts, Lead Nurse at Leatherhead Community Assessment Unit which is operated by Central Surrey Health, takes up the story and reveals there are some very real benefits to be gained from testing and treating patients in the community.

“In November 2005, the team at the Leatherhead Community assessment unit were tasked with moving their services into the community. Previously we had worked out of the acute hospital, testing patients, putting them forward for referrals internally, or providing treatment as appropriate. While we were generally considered to be functioning well, government targets and the change from trolleys to beds meant our unit ceased to function as a full assessment unit. The decision was made to move us into the community to support patients at a primary care level and help prevent emergency admissions.

“The service was initially quite tricky to set up – we didn’t have long to get going. We needed to work closely with GP surgeries and our colleagues to educate them about what was on offer and, in the first instance, we were only given funding for three months.

“However, we worked hard and patients started coming to the unit from their local GP, as well as the acute trust and the ambulance service. It quickly became apparent we were going to become a more permanent community fixture.

“At the start of the service we saw approximately 90 patients each month with a wide variety of conditions. Some had suspected heart failure, were new patients with atrial fibrillations or were suffering with cellulitis and deep vein thrombosis. Others needed testing and treatment for chest infections, asthma and COPD. There was however one piece of common ground. If these patients hadn’t come to our unit, they would have ended up at the local A&E department. There they would probably have had a series of tests, before being admitted to a bed for a potentially lengthy period while samples were sent for analysis at the hospital laboratory.

“As our initial period of funding came to an end, we used the national tariff for emergency admissions to calculate how much money we were saving the local trust. The figures were startling and totalled between £25,000 and £30,000 each month.

“Suffice to say our funding continued and by the end of our first year we had saved £600,000 net. Today, just three years on, we see in excess of 250 patients a month that would have been sent straight to the acute hospital – not bad numbers for an assessment team of just four people who cover a catchment area with a population of more than 280,000.

“So how has such a small team managed to work so effectively? Well, from the start we knew we needed to differentiate our service by employing equipment that would enable us to give patients their test results quickly. With our main emphasis being on quality patient care, we wanted to make informed decisions within a matter of minutes about the kind of treatment required to get patients back home, or on to the hospital for further assessment if required.

One of the first pieces of equipment we purchased was the i-STAT; a unique handheld analyser from Axis-Shield UK. We use this device to perform a range of tests including oxygen trials on patients with COPD who are at high risk of emergency admission. Prior to our set up, patients needing these tests would have been seen as day cases in the local hospital and would have had to wait around for their results. We work very closely with our respiratory team and are now able to perform these tests and give patients their results quickly.

Using devices like i-STAT has improved our patient management, helped cut result times and made for a relaxed atmosphere, which is very different from the typical hospital environment.
Patients like the service we offer and cannot believe how quickly we can obtain their results. Patients needing oxygen trials or infusions are made comfortable for a slightly longer visit but our average turnaround time for assessment is now just 24 minutes – a number which really does speak for itself.

Looking ahead, now people know about our unit and what can be achieved in the community, we are keen to further develop our patient services. We are working closely with local GPs and other health care professionals to find out how they would like us to expand our services. We are also working with other care trusts to provide consultancy and help set up other similar units in different regions around the country.
The Medical Assessment Unit at Leatherhead Community Hospital is open Monday to Friday from 9am to 6pm. It is operated by Central Surrey Health – a not for profit, limited liability company owned by and employing local therapists and nurses. For more information please contact: Sam Scarrott on 020 8394 3840 or alternatively visit: www.centralsurreyhealth.nhs.uk
For more information about i-STAT from Axis-Shield UK please visit www.axis-shielduk.com or alternatively contact Sue Younghusband on 01480 862100.

Written by admin
Filed under: COPD-Related News