Reducing hospital referrals by 50% for diabetic patients in Liverpool

Liverpool Diabetes Partnership (LDP) is meeting demand and has drastically cut referral-to-treatment times by using EMIS Web to deliver truly connected care.

In just four years, how patients with diabetes are treated across Liverpool has been completely transformed thanks to a targeted multidisciplinary service that’s using EMIS Web to access shared patient records at the point of care.

The Liverpool Diabetes Partnership (LDP) was formed in partnership by Aintree University NHS Trust, The Royal Liverpool and Broadgreen University NHS Trust, and Mersey Care NHS Foundation Trust. Created as part of the Healthy Liverpool Vision, the service aimed to both reduce hospital admissions and deliver proactive care closers to patients’ homes. At that time, Liverpool also had the third highest prevalence of diabetes in the country.

“People are being seen in the right place, at the right time, by the right person.”

Jan Fennell-Rutherford, operations manager, Liverpool Diabetes Partnership

With the support of our clinical technology, LDP has done far more than achieve just their founding goals. Healthcare professionals across primary, secondary and acute settings in Merseyside have improved their relationships and are having better conversations by being able to instantly access and edit patient information wherever they are via EMIS Web and EMIS Mobile. Their improved collaboration has meant that not only have hospitals admissions reduced by 50%, but that patients are seen within a week of referral to LDP since the service is providing the capacity needed to meet demand.

Going paper-free at the point of care

Removing the need to rely on paper records has played a big part in the service redesign’s success. Now that they’re using electronic templates – including custom ones that LDP has created – clinicians across disciplines can capture data and update patient records in a structured format.

“Before the templates, there was no actual information,” explains David Abram, diabetes team lead for Mersey Care NHS Foundation Trust. “The only way for clinicians to access that information was for them to come into our department, ask us for guidance and then go into our files.”

“Now everyone can see everything,” says Collette Kelly, diabetes specialists nurse at LDP. “We don’t have to find the time to physically seek clinicians out because we’ve got access to all that information.”

“There’s no going back through, dictating and looking over notes.”

Jan Fennell-Rutherford, operations manager, Liverpool Diabetes Partnership

The templates aren’t just saving LDP time by ensuring everyone has real-time views of patient information though. Recording notes is speedier than ever before and care is easier to provide in patients’ homes too, since data entry is standardised and can be completed when remote using EMIS Mobile. Plus, healthcare professionals throughout the service can automatically create and send electronic letters using the templates – something that’s also cut printing and postage costs.

“Consultants are generating their own letters,” details Jan Fennell-Rutherford, operations manager at LDP. “If we run a clinic in the morning that finishes at 12.30pm, GPs will have the letter from those clinics by 2.00pm at the latest. Consultants aren’t having to lengthen their appointment time to do it either. They can move onto the next patient and the GP doesn’t have to wait for weeks for the letter.”

“The templates in EMIS Web have been a god send.”

David Abram, diabetes team lead for Mersey Care NHS Foundation Trust

Helping clinicians across specialities to deliver safe and connected care

Having the same access to shared notes has benefitted clinical relationships, with healthcare professionals now finding that they’re having more valuable conversations and are collaborating more effectively. When it comes to delivering safe, informed and efficient care, it’s made a big difference.

“Previously, you’d get a phone call and then you’d have to make another call yourself to gather all the information from different areas,” says Collette. “Now you can be having that conversation whilst you’re gathering information. You don’t have to have as lengthy a conversation either. You’ve already got the gist of what’s needed and the problem solving becomes easier because you can see everything. The other clinician doesn’t have to repeat all of the details.

It makes our care much safer as we don’t miss a bit of information out of a telephone conversation. If the consultant’s got all that information and a patient’s test results in front of them, they can make a far safer decision.”

“We have all the information we need. It supports decision making much better.”

Collette Kelly, diabetes specialists nurse, Liverpool Diabetes Partnership

Jan also details how information sharing has meant that some calls are no longer needed at all, something which has made patient interactions more focussed. “Now the consultants know that they can access the GP record, they don’t need to ring up the GP and wait for a fax,” she details. “When the patient is in front of them, they have that information. It’s improved relationships and made the communication quicker.”

Targeted care packages that give patients a better experience and better outcomes

As a complex condition, diabetes is often treated across different specialisms which can result in disjointed care. But by being able to truly deliver a connected multidisciplinary service, LDP has been able to tackle this issue head on – and provide patients with a better experience in the process.

“Patients have noticed the difference. The fact that the GP knows what’s happened – they love it. It works how patients expect it to work,” explains Collette.

“It’s that continuation that’s much better for the patient,” agrees Jan. “That’s the thing that patients complain about – people not speaking to each other. With EMIS Web, it doesn’t matter when a patient moves because we can see what medication they’ve tried before, we know they’ve seen a dietician – all that information’s there.”

“Patients are getting a better service because clinicians are getting a better service from EMIS Health.”

Jan Fennell-Rutherford, operations manager, Liverpool Diabetes Partnership

Our clinical technology is also supporting LDP to easily manage both clinics in real time and demand by practice and neighbourhood. With a better handle on their capacity, LDP is giving patients greater choice of where they receive care. “We can book patients into any clinic that they wish, at specific times, locations and so on.” explains Collette. “If they’d rather a clinic closer to work, closer to home, an evening session – whatever – then we can accommodate that. Patients can go where they want, whether it’s evening or day time.”

These improvements aren’t just benefitting those who already have diabetes either. Search and Reports within EMIS Web mean that teams can collaboratively identify cohorts of patients at risk of developing diabetes and make targeted interventions. With teams of experts working to prevent the condition from developing in the first place, people across Merseyside are experiencing better care and better health.

“If you get a referral today, you can be seen next week by a consultant.”

Collette Kelly, diabetes specialists nurse, Liverpool Diabetes Partnership

Better outcomes and out-performed targets

All of these improvements have cumulatively had a big impact, and have helped LDP to either meet or exceed their targets. By being able to provide a week’s turnaround time to see those who’ve been referred to them, LDP have cut hospital appointments and waiting times, and are working towards national goals, including the NHS’s Long Term Plan’s aim of reducing one third of hospital outpatient appointments. The reduced waiting times have also meant that the service has exceeded their target of reducing complications.

As Jan explains, “We’re seeing patients more frequently. Previously, a patient would come in and we’d need to see them in six months but there wouldn’t be an appointment available for 15. Now we have examples where consultants are discharging patients after seeing them three times in the last year, and if anything happens to that patient again, they’re being told to speak to us. Transitions that were falling through the net are being picked up now. It’s improved secondary care’s capacity to see complex patients.

The number of referrals to Aintree Hospital are now minimal. They have 50% less patients coming through their doors because we’re looking at those 50% of patients. We’ve done the same for the Royal Liverpool and Broadgreen University NHS Trust too. The referral-to-treatment time in Aintree is four weeks for diabetes and the Royal is down to about 16 weeks – those are better than the 18-week target. Now if patients are referred to hospital and it’s an inappropriate referral, they’re sent to us and we triage them.”

Setting an example for other services

Clinicians throughout LDP have already started sharing their story with other services in the hopes that both their use of technology and their successes can be replicated throughout the UK.

With the NHS spending around 10% of its budget (about £10 billion) each year on diabetes – and with the costs set to increase with 17 people newly diagnosed with the condition every hour – getting on the road and lending their expertise to others could really make a difference. It’s been estimated that better management of diabetes could save the NHS £170 million a year, and it’s with innovative service redesigns like LDP’s that these aims can be achieved.

For Ian Bailey, our own head of product management and clinical lead, the effect that LDP has had on diabetes care is clear: “I spend a lot of time going round the country talking to clinicians and this really is blooming good stuff!”

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