06 / 03 / 2014
In Bassetlaw, commissioners and providers have been working in partnership to enable consultant-delivered care seven days a week, reduce variation and improve clinical outcomes through a new model of care.
Results and benefits
- Reduced variability in patient experience, quality of care and outcomes, with a 12 per cent reduction in standardised mortality and a reduction in average length of stay of at least one day for non-elective medical patients since the assessment treatment centre (ATC) was established.
- The skill mix and experience of staff supporting the ATC has improved due to a rotation system enabling them to gain a variety of skills as a part of a multi-disciplinary team. Improved staff morale, team working and training has contributed to an environment that offers ongoing development.
- A&E is now supported with a clinically robust follow-on service. There has also been a reduction in locum staffing and a decline in inappropriate hospital stays.
What the area did and why
The drive to redesign the non-elective medical pathway at Bassetlaw Hospital was largely due to delays in assessments and treatment planning following admission. Evidence from a 2011 external audit highlighted higher weekend mortality rates and that 14 per cent of admissions to Bassetlaw Hospital were avoidable.
During 2011/12, Bassetlaw clinical commissioning group, primary and secondary care clinicians with community and social care providers worked jointly to develop the assessment treatment centre (ATC), a unit for medically ill patients with seven-day consultant-delivered care.
The ATC opened at Bassetlaw Hospital in November 2012 and receives patient admissions from A&E, GPs (in hours and out of hours), community services and ambulances. It has 21 beds with access to diagnostics, and enhanced pharmacy and dedicated social care support. An acute physician is present Monday to Friday, and a general physician at the weekends, resulting in consistent, high-quality seven-day consultant-delivered care.
Additionally, the community rapid response service supports patient discharge over seven days.
The ATC also has a non-bedded ambulatory day care facility for patients with conditions such as deep vein thrombosis (which clinically do not require the patient to be admitted) to attend the unit for treatment and go home.
Early evaluation shows the ATC has improved clinical outcomes and patient experience, showcasing collaborative working with staff across health and social care boundaries to deliver high-quality care. Underpinning this collaboration has been a cultural shift among clinicians and managers with a focus on shared responsibility and leadership both at a system and organisational level.
The ATC is an evolving model that will continue to strengthen its cross-sector links to deliver a robust service, including the potential to co-locate and integrate A&E and ATC at Bassetlaw Hospital.