Dr Foster Intelligence | Case studies

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Success stories

Patients with uncontrolled respiratory and heart conditions were some of the most frequent hospital attendees. This system is allowing us to identify patients at risk of hospital admission more easily and enabling us to spend more time on caring for them.

Barbara Brady Consultant in public health

Knowing where the risks lie

In Nottinghamshire, unnecessary emergency admissions cost £2.5million in the last year. The former Ashfield and Mansfield District Primary Care Trust, with a care area of more than 70 square miles and a population of nearly 200,000, tackled the problem with 11 community matrons.

Before the introduction of Dr Foster Intelligence's tools, the matrons relied on paper notes and letters from the hospital to identify the most vulnerable patients. Using the High-impact User Manager tool, the matrons now have a clear picture of which patients are being admitted, where, and for what condition. The system 'risk profiles' each patient according to their past history, tracks the reason for their admission, and logs the cost of that admission. This also helps those who are commissioning services, whether at GP practice level or within the PCT.

[more info] Emergency admissions for COPD, trended over 8 years. The blue shows where the number of admissions is at the expected level (i.e. in line with the national average). If the symbol is red then the number of admissions is worse (or higher) than expected, and green is where the number of admissions is better (or lower) than expected.

Solution

That knowledge allowed the matrons to prioritise their caseloads by condition, which resulted in a reduction in hospital admissions and improved overall patient care. Nurses were able to educate patients on methods of managing their conditions that did not involve a hospital visit.

This proved especially important for elderly patients or those living alone because educating them about managing their conditions gave them confidence in handling certain situations. Patients who understand their condition are likely to seek the more appropriate solution of either managing themselves or contacting their community nurse or GP. They therefore avoid the unnecessary stress of a barrage of tests that is the likely result of a hospital visit.

Matron Michelle Wilson says, "There are many patients with chronic conditions who have had the same treatment for years. Some are not as well-controlled as they could be because their condition has worsened or because there are now newer, better drugs available. In the past, it's been luck as to whether I came across them in the reams of paper I scan. This electronic system helps me to focus on patients for whom I can make the most difference."

Outcome

Ronald Sheppard, a patient who is being treated by Michelle Wilson, has seen a definite improvement in his care."Sometimes I used to get up in the morning and it was panic stations - I couldn't breathe and had to call an ambulance. But now Michelle has taught me to control my panicking, steady my breathing and use my inhalers properly.

"She made sure I had the right medication, talked me through depression, and above all, kept me out of hospital. She's given me a new life. Her visits are a breath of fresh air."

Work like this is making hospital admissions more efficient and thus better for the patients. Barbara Brady, a consultant in public health, agrees. "Patients with uncontrolled respiratory and heart conditions were some of the most frequent hospital attendees. This system allows us to identify patients at risk of hospital admission more easily and enables us to spend more time caring for them."

Tool

High-impact User Manager