Chronic Respiratory Disease Management in Brent

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Chronic Respiratory Disease Management in Brent

• A System-wide Approach

Dr Vince Mak Central Middlesex Hospital
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Philosophy 7 main concepts
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Aims of the Service

• Delivery of high quality seamless care for
  chronic respiratory disorders from disease
  prevention to intensive care and palliation
• Removal of boundaries between primary and
  secondary care and dependence on secondary care
• Reduce inequalities in access and variation in
  quality of care
• Enable majority of chronic disease to be managed
  in the community
• Increase patient compliance and effectiveness of
  self care

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Starting point

• Current lack of coordination of services
• No one thing is going to achieve our aims
• Multiple pronged approach will be required
• Total overhaul of current system of healthcare
  delivery
• Gradual evolution over last 6 years

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Indicators of High Quality Care?

• Patient satisfaction
• Reduction in emergency admissions
• Reduction in length of stay
• Reduction in outpatient referrals/follow ups
• Ease of access to expert opinion/advice
• Ease of access to diagnostics

All of these factors are inter-dependent
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Initiatives

• Inpatients
• Outpatients
• Primary Care
• Patients

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Inpatients

• Protocol driven care
• Triage to specialist within 24 hours
• Ease of access to NIV/ITU
• Nurse/physio led ward based NIV service
• Early discharge/acute home care teams
• Chronic Respiratory Disease Nurse Practitioner
  (CRDP)

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Outpatients

• Less severe patients managed by own GP
• Manage DNAs (30 to 0)
• Severe chronic care patients looked after at home
  by CRDP ease of access by patient
• One-stop COPD clinic for new/problem patients
• Email/virtual clinic (24 hr response time)
• Daily consultant led clinics
• Ease of access to consultant opinion (less than 1
  week for routine appointment, next/same day for
  urgent cases)

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Primary Care

• GPSIs (3-4) with 2 sessions each
• Run locality based open access spirometry clinics
  with CRDP (smoking cessation)
• Open access same day reported CXR service with
  fast-track for abnormal films
• GPSIs work with CRDP with case management to
  prevent admission
• GPSIs to increase basic standard of respiratory
  care amongst colleagues
• CDRPs to improve education of practice nurses
• Locality based pulmonary rehab run by CRDPs

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Patients

• Expert patient scheme
• Increase awareness/education of public with
  regard to respiratory illness (CRDPs)
• Patient education in One-Stop clinic
• Spirometry screening in targeted pharmacies along
  with smoking cessation

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Model for Respiratory Care
RRgt25 Tempgt39 BPlt100 PRgt100 Confusion Sats
lt95 PFlt50
Email Clinic (Opinion within 24hrs)
     
Resp Clinic (24 hrs
Unclear
Email Clinic
Acute (No Previous Resp problem)
Urgent Admiss Required
No
Hosp Specialist Opinion
Resp Clinic
Yes
AE Refer to Med Reg on call
Resp Problem ? Refer
Email Clinic
Require Urgent Admission (CRB-65)
Unclear
Acute on Chronic
Emergency Assessment
PwSI At home
Chronic
Email Clinic
A E Assess By Resp Team
Yes
PwSI/GPSI. Review severe chronic disease
patients at home Mod/Severe in locality setting
One Stop OPD Clinic (Within 1 week)
Long Term Maintenance
PwSI/GPSI
No
PwSI/GPSI In Local Setting