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Providing low-level intensive care over a short period, this service focuses on hygiene, nutrition, emotional support, and daily activities to enhance patient well-being. Through rapid response and practical care, it aims to reduce hospital admissions and promote overall health. With a cost-effective approach and significant cost savings, the service has garnered positive feedback from patients and healthcare providers. The future plan includes expansion and evaluation to enhance outcomes and extend the benefits to a wider community.
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CICSS Crisis Intervention Community Support Service Tony Marsh
What is the issue? • Financial Context – non-elective spend • Hospital can be bad for you • Intermediate Care Step Up beds • Reasons for admission in frail elderly • Significant physical illness • Social vulnerability • Clinical uncertainty/need for observation • Social Services response • Gedling Action Team
Who Are We? • 21 practices • 133,000 patients • Practice Forum • Executive Board • Emergency Care Task and Finish Group • Part of Greater Nottingham Health Community but Notts County PCT
Why CICCS? • British Red Cross already supporting ED discharges: “Home From Hospital” • Social support model – not clinical • Excellent contacts/signposting ability • Service design a two-way process with bilateral input between commissioner and provider • Run as a pilot initially
Service Model • Rapid response service providing low level intensive care over a short period and ensuring a longer term outcome • Patients can be seen within 1 hour of receipt of a referral • Patients are seen for a maximum of 4 weeks • Care addresses: • Emergency Hygiene Needs • Nutritional Needs • Emotional Needs • Activities of Daily Living • Medication Prompts • General Well-Being
Service Model One Simple Telephone Call “Make it easy to do the right thing” Hours of Service Monday to Friday 7:00AM to 11:00PM Saturday & Sunday 8:00AM to 12:00PM and 5:00 to 10:00 PM
Overview of Service to end Feb. • 289 Referrals Accepted • Referrals have been received from all Practices within the cluster • Number of daily visits per referral – 1 to 4/day • Expanded the service: • Referrals into and out of existing Intermediate Care Service • Medication Reviews by Practice Pharmacy team • B3/D57, acute medical admission unit at QMC • Falls assessment By CICCS Community Workers
Cost • Cost of Service = £151,000 p.a. • Average cost/patient referral = £320.00 • Average cost/episode of care = £6.00 • Average cost for non-elective admission minimum £2,400 • BUT how many admissions avoided?
Benefits & Evaluation • Estimated avoided hospital admissions = 45% of Referrals: (based on asking the referrer) • Estimated cost savings of approximately £453,000 (based on above) • Evaluation: • Patient & referrer feedback • Hospital Admissions pre & post x 12 months • A&E attendances • Falls Prevention • Whole Systems Analysis • Outcomes
The Future • Evaluation • Roll out? • Using “the Third Sector” • Flexibility in service delivery, • “Can do” attitude • Unhampered by red tape and bureaucracy. • Something that they can’t do, they’ll find someone who can. • A well respected charity opens many doors. The British Red Cross has a wealth of knowledge of the number of agencies and services offered in the community, • The organisation is noted for being reliable, trustworthy and non threatening by patients. • An example of the charity’s commitment was during the recent bad weather. • Excellent feedback to GP
