What was the problem?

The current rehabilitation care pathway for acquired brain injury (ABI) patients in North West London (NWL) is fragmented and hard to navigate, as it relies on access to services with multiple providers. This prevents appropriate and timely rehabilitation, with a negative impact on overall patient experience and outcomes.

The current referral process from acute care to rehabilitation:

  • Is extremely complex and outdated (faxes are the primary means of referral)
  • Is challenging to categorise patients to the appropriate care level
  • Lacks visibility into services available and available capacity across providers
  • Requires clinical staff to devote time and resource to chasing referrals, unsure if they are being picked up at the other end
  • Redirects clinical time from patient contact to administrative tasks
  • Varies significantly in referral to admission time, complicating acute bed planning further up the system

What we did and why

To improve the neurorehabilitation referral process from acute wards to inpatient and community services, Imperial College Health Partners AHSN (ICHP):

  • Consulted with neurorehabilitation practitioners and commissioners across the region to clearly articulate the problem (patients not getting the right therapy at the right time because of inefficiencies in the system)
  • Made the case for and secured an increase in capacity
  • Collectively worked with providers/ commissioners to build a sustainable community network
  • Identified an existing technological solution (BadgerNet, used for maternity services)
  • Worked with providers and industry to customise the technology for the therapeutic area
  • Standardised and implemented the referral form
  • Measured impact of innovation and secured future CCG funding to sustain programme

Our solutions included:

  • Customisation of an e-referral system in consultation with care providers
  • Deployment of an e-referral system across all neurorehabilitation care providers and referrers in NWL

ICHP Neuro 482This pathway change was targeted at:

  • Patients requiring neurorehabilitation moving from acute care to rehabilitation services
  • Neurorehabilitation practitioners (therapists, clinicians, nurses) looking to provide the appropriate level/ type of care
  • Commissioners looking to commission the appropriate care for patients, gaining value for money by ensuring an efficient pathway into neurorehabilitation services

The work was rolled out in:

  • Eight referring hospitals
  • 15 neurorehabilitation units, including:
    • Eight Level 1 units (NHSE-commissioned, highly specialised units for the most complex patients)
    • Five Level 2b units (CCG-commissioned specialised units for complex patients who don’t meet Level 1 threshold)
    • Two Level 3 units (least complex patients who still require some in-patient rehabilitation)

Commissioners, academia, NHS England and clinical teams collaborated to increase transparency around improved referral process.

Which national priorities does this work address?

Care and quality gap (5YFV):

  • Improving standards and ensuring access to care
  • Harnessing digital technology / ‘going paperless’
  • Integrated care

Funding and efficiency gap (5YFV):

  • Referrals to direct patients into the right unit, generating efficiencies over time
  • Commissioning the right services for their local populations

Contribution to economic prosperity (AHSN priority)

  • Cutting referral to admission times
  • Reducing costs
  • Saving acute bed days
  • Clinicians are able to spend less time on administration
  • Commissioners are able to make informed commissioning decisions based on local service needs

Adoption and diffusion of innovation (AHSN priority)

  • Taking a product from a different therapy area (maternity) and tailoring it to neurology
  • Taking an existing waiting list product and building it to become a referral system

Results

As a result of this intervention, between September 2015 and February 2016, 167 patients were referred to L2b and L3 neuro-rehabilitation services, with the following outcomes:

  • ICHP Neuro 1700Provision of clinical information on referral was improved and standardised, allowing more accurate assessment
  • Referral to admission times have almost reduced by half (17.37 days to 9.78 days)
  • Costs reduced, on average, by £1700 per patient – prior to this innovation, patient demand had never been captured on a system-wide basis
  • Saved 482 acute bed days over five months, leading to £107,000 worth of savings
  • Staff satisfaction has drastically improved, having previously been weighted towards 1 – 3 out of 5 (with 1 meaning poor and 5 meaning excellent), with staff now reporting exclusively 3, 4 and 5.

As a result of the programme’s success, both on key performance indicators (KPIs) and anecdotally, the eight referring CCGs have agreed to fund this initiative in future, guaranteeing sustained improvement.

Next steps and spread

The eight referring CCGs have agreed to continue funding this initiative, guaranteeing sustained improvement of neuro-rehabilitation services in North West London. The project’s lessons learned are now being shared with other AHSNs across the country.

Find out more

Visit the project summary page for more information.

Visit the Imperial College Health Partners AHSN website.

Contact for help and advice

Ronke Akerele, ICHP Director of Programmes
Change and Performance Management
Ronke.akerele@imperialcollegehealthpartners.com

Programme duration: Spring 2014 – Spring 2016