Reduction in Unnecessary admission though Formative Evaluation & Education (RUFE): an independent formative evaluation of the virtual ward programme and urgent care centre
A service evaluation:
Registered with the Clinical Audit Office at St. George’s Healthcare Trust (Ref: 2954)
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.- Completed, draft report in circulation.
- 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.
To conduct a formative evaluation of the Virtual Wards
The subjects of the evaluation are the health care professionals in the Virtual Wards. Their effectiveness will be judged based on changes in the management of the population eligible for referral to virtual ward. Data will be analysed by locality. Only adults, fully registered with local practices will be included in the metrics.
Primary care localities in NHS Wandsworth (if data were available, we will explore finding a comparator group of people from another borough)
There will be three strands to this formative evaluation
1. Feedback to Virtual Ward team about outcome measures:
a.. Total numbers of admissions
b. 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.
b. Ambulatory Care Sensitive Conditions
2. Quarterly Audit-Based Education workshops where data will be fed back and ward staff and other stakeholders will explore and model how their service impacts on the quality of care.
3. If feasible 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 when there is increased activity in the community.
4. 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 if feasible ascertain: (a) Pre-admission PARR score or other risk 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 potentially avoidable admissions.
Secondary outcome measures:
Overall change in admissions
Admissions where not procedure is carried out
Readmissions in 28 days
Process of care mapping – in the workshops where practitioner reflect on where the virtual ward might impact on the process of care
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.
A service evaluation registered with the Clinical Audit Office at St. George’s Healthcare Trust (Ref: 2954)
- RUFE Summary
- RUFE Baseline Data Report
- RUFE updated Baseline Data Report
- RUFE Steering Committee Meeting (10 January 2012)
- RUFE Project Team Meeting (10 January 2012)
- RUFE Project Team Meeting (13th March 2012)
- RUFE Advisory Board Meeting (26th April 2012)
- RUFE Project Team Meeting (26th April 2012)
- RUFE Advisory Board Meeting (22 May 2012)
- RUFE Operational Team Meeting (22 May 2012)
- RUFE Steering Group Meeting (25 Sep 2012)
- RUFE Meeting 26th Feb 2013
Wandsworth Mid-Year Population Estimates
Please click here to download 2010 mid-year estimates of the population of the borough by age and gender.