This project arose from the PenCLAHRC research question prioritisation process. It was ranked highly by PenCLAHRC partners on potential for health gain, size of the problem and alignment with current priorities. Originally, worded to investigate the effectiveness of services in reducing acute admissions, it became apparent that variation in care existed across the region and that the current provision of this type of service was not well understood. This project is therefore proposed to meet a gap in knowledge of current health systems in the region.
Preliminary discussions with two local organisations indicated that community rapid intervention services vary in their scope and configuration across the South West Peninsula, both within and between organisations. The National Audit of Intermediate Care, which had been identified as containing these data, do not report these service variations and their structured categorisation created some doubts regarding data representation. Therefore, in order to better understand how rapid interventions, also known as crisis response, services work and what contributes to effectiveness, we first need to understand the baseline variety present in current services.
To identify and map all services in the community that have been commissioned to provide a rapid intervention for people at risk of being admitted to hospital.
- To describe the current range of services available regionally
- To identify characteristics thought by providers to contribute to the success of their service
- To share current thinking on Rapid Intervention service development
An initial investigation identified that the National Intermediate Care Audit, conducted by NHS Benchmarking, collected data falling within our remit but described with different terminology – as Crisis Response. Many of our regional stakeholders participated in this audit. Rather than create our own data collection tool, it was decided to engage with stakeholders about their audit data, asking specifically for crisis response/rapid response services/urgent intermediate care referrals.
We engaged with stakeholder and service providers to identify where and how rapid interventions are being employed in the community.
- Stage 1: Contact CCG leads by letter (jointly from AHSN and PenCLAHRC) to request information on services they provide and contact details for services they commission, including audit data if available. In addition, use local contacts and networks to identify named leads for rapid response and intermediate care services.
- Stage 2: Follow-up all regional contacts, asking for the same data, plus any additional information regarding services that is not covered by the audit.
- Stage 3: Collation and analysis of data, with a focus on mapping services and identifying potential gaps in the data provided.
- Stage 4: Share reported findings at a stakeholder event.
Contact with service providers was initiated in writing from the AHSN and PenCLAHRC collaboration. Follow-up was conducted by the PenCLAHRC team, face-to-face, by telephone and e-mail.
Data was collected on:
- A description of the rapid intervention services (including differences within the organisation)
- Referral criteria to the service
- How the service is triggered/referral pathways
- Time from referral to contact visit
- Hours of service provision; days and times
- Geographical coverage
- How the service is organised e.g. triage by phone, face to face visits, follow-on care
- How any named/key workers/co-ordinators are used
- The range of functions carried out by the service
- How the service connects with other health service provision (planned interactions, actual delivery, outsourcing, co-location where applicable)
- Staff involved in delivering the service –how many, what roles and grades (including administration)
- The budget allocation for the service; staff and resources.
- What prompted the service to be established
- Number of referrals
- Service audit information
- What data are collected by the service?
- What expectations for the service performance do they have?
- Do they have any expansion or extension plans?
In addition to the above data any documents pertaining to the service were collated, such as patient information leaflets, on-line information, written service agreements.
The data was analysed descriptively, summarising service coverage, both geographically and by patient type.
Public & Patient Involvement
The initial project prioritisation process was attended by two PPI representatives and a PenCLAHRC PPI team member. PPI was ongoing throughout the project and dissemination process.
Rapid Intervention Services form part of a dynamic changing organisational landscape. Given this environment, our project has found that services have evolved in many different ways to fill niches in their local care pathways. We can make the following overarching observations:
- The project highlighted that services had evolved differently to cater for specific local demand, rather than having a consistent approach across the region. Although, in general terms, teams were working towards a shared goal of adopting a more integrated approach to patient care and seeking evidence to guide their progress.
- There is a lot of innovation (initiating ambulance divert practice and development of staff roles).
- Sharing the experience of working in this area would be valuable.
- Information is not sufficient to guide service development and the National Audit is felt to be of limited value.
- Integration between service elements was consistently felt to be positive and helps with speed of response as a crisis is unfolding. This enables rapid access to community resources, e.g. equipment is a critical element of crisis response and is supported by integration.
A shared learning event held on 6th October 2016 brought together service providers and commissioners in the region to discuss study findings. The event allowed attendees to share information and experiences and facilitated the development of a network of people with shared interests in admissions avoidance.