RUFE
Project title:
Reduction in Unnecessary admission though Formative Evaluation & Education (RUFE): an independent formative evaluation of the virtual ward programme and urgent care centre
We are proposing a three phased process:
- Pilot to engage stakeholders and demonstrate that they are willing to participate in this process and that we can identify, extract and link pilot data.
- Two substantive project phases:
- Phase 1: Formative evaluation of impact of current services on admission of patients eligible for their services where no procedure is carried out. Simultaneous assessment of admission threshold in A&E.
- Phase 2: Handover and embedding of these evaluative processed into locality structures.
Objective:
To conduct a formative evaluation of the Virtual Wards and Urgent Care Centre.
Subjects:
The subjects of the evaluation are the health care professionals in the Virtual Wards and Urgent Care Centre. Their effectiveness will be judged based on changes in the management of the population eligible for referral to virtual ward or Urgent Care Centre service. Data will be analysed by locality. Only adults, fully registered with local practices will be included in the metrics..
Setting:
Primary care localities in Wandsworth PCT (if data were available, at no cost, we will explore finding a comparator group of people from another borough)
Method:
There will be three strands to this formative evaluation
1. Feedback to Virtual Wards and Urgent Care centre about short term admissions in adults (eligible for their services) for short stays: 0 to 3 day admissions. We will only include admissions where no procedure is carried out.
2. Adoption of the Appropriateness Evaluation Protocol (AEP) for use in A&E at St. George’s, subject to agreement to ensure that admission thresholds don’t change.
3. Handover of tools and techniques to enable in-house on-going monitoring of performance.
The evaluation will be formative – i.e. There will be open feedback of – as we are looking to change behaviour with regular Audit Based Education (ABE) sessions where data about 0 to 3 day admissions with no procedure is carried out. For this group we will ascertain: (a) Pre-admission PARR score – and appraisal if this person would have been eligible for one of the interventions being evaluated; (b) Analysis of whether and how that admission might have been avoided by these services.
The project will run in three stages: Pilot – proof of concept, stakeholder engagement to construct a requirements analysis. Phase 1: Round 1 formative evaluation; Phase 2: Second formative evaluation and handover of process.
Primary Outcome measure:
The primary outcome measure will be the reduction of the rate of short adult admissions where no procedure is carried out.
Secondary outcome measures:
PARR scores for people admitted and those attending community interventions or other measure (e.g. HowRu); Number of Disease Registers of people admitted and attending services (measure of chronicity); Readmission rates; Other healthcare utilisation; Method of conveyance to A&E (are admissions linked to arrival by ambulance); Death or other critical incidents.
Operation of RUFE
RUFE will have three elements:
(1) Liaison and feedback using an audit based education via a locally run working group.
(2) Data collection, processing, and analysis
(3) Set up structures, processes and data flows that will be in place beyond the life of the project.
Available downloads:
Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison
