Evaluation of Unscheduled Care Coordination Hubs

ARC Yorkshire and Humber collaboration with Yorkshire and Humber Academic Health Science Network

Emergency department crowding and rising emergency admissions currently places unsustainable demands on acute hospital services, a proportion of which is avoidable transfer, attendance and admission in patients with immediate needs but are not seriously ill. The pandemic has also accelerated existing NHS priorities for innovative ways to manage patients with unplanned care needs in order to reduce the dependency on already overstretched hospital services. Unscheduled care coordination hubs represent a promising post pandemic approach to deliver comprehensive assessment and care in community settings for patients with immediate health needs. There is a high risk of these patients attending hospital, which is partly due to a lack of understanding about availability of clinical services to deliver care in the patient’s normal place of residence. In addition, the process for accessing services directly can be time consuming and complex. These patients could have their care delivered by community services who may know them and can provide the right clinical support and access to tests, but allow them to stay in their own home.

The unscheduled care coordination function operates from a physical hub, staffed by clinical and non-clinical professionals. They are dedicated to unscheduled care and not involved in delivering planned care services. Developed by the NHS England and Improvement (NHS E&I) Emergency Care Improvement Team (ECIST), the hub model has defined principles of care underpinning its delivery including:

  • a single point of access for ambulance service staff, primary care, care home staff and nursing teams to refer patients;

  • rapid transfer of clinical responsibility for patients’ ongoing management from referrer to a senior clinician in the hub;

  • access to acute diagnostics, same day emergency care and virtual ward rounds with consultant physicians;

  • Advanced Practitioners working in the hub can attend a patient in their normal residence within a 2-hour timeframe if clinically appropriate.

This multi-faceted intervention has the potential to reduce clinically preventable unplanned attendances and admissions to hospital by providing a timely, comprehensive community response to patients who will benefit most.

Project rationale

Our Urgent and Emergency Care theme and the Yorkshire and Humber Academic Health Science Network (YHAHSN) are undertaking an 18 month study to accelerate both the evaluation of this new care delivery model and provide rapid insights about effective implementation of the models nationally. It will focus on the impact of care coordination hubs on unscheduled care activity, with a focus on how they can contribute to system resilience and benefit patients by reducing hospital attendance and admissions. The project will consider the impact on health inequalities by assessing access to and quality of unscheduled care in the care hub model for deprived populations, populations known to be high users of emergency care services with worse outcomes.

Project description

NHS England and Improvement ECIST piloted the care hub in North Staffordshire and rolled out the model in Wolverhampton & Norwich, with at further site in Yorkshire and Humber (YH) currently in implementation. Our ARC is undertaking the evaluation in the three pilot sites, to feed forward insights to actively support the implementation of the model in the new YH site. The key elements to the project area are:

  • Evaluating the patient activity and referral patterns of the three pilot sites and assessing their impact on emergency care, such as numbers attending hospital. Part of the analysis of this data will consider the extent to which particular population groups are under or over represented

  • Interviewing key clinical and non-clinical hub staff from other services referring into the hubs to understand their perceptions and experiences of the hubs, to include exploration of reasons for any over or under representation identified in the analysis of patient referrals.

  • Evaluating and supporting implementation work underway in the new YH hub site.

  • Findings from the above work will assess the overall success and impact of the pilot care hub models. A ‘principle based’ implementation guide for adoption and implementation of the model will be produced, providing flexible guidance to reflect different system configurations.

By focusing on these elements the project team will assess whether the care hubs are achieving benefits for patients and the UEC system by examining the following:

  • The extent to which hubs are delivering care closer to the patients’ home and conveyance to hospital is reducing safely.

  • Acceptability and sustainability with stakeholders, and where possible patients and carers.

  • Learning and knowledge to maximise successful implementation, effectiveness for patients and sustainability of the models for staff and the system they operate.

  • Evaluation of the key elements that deliver successful implementation and impact for the care hub design will produce principles for place-based systems that ensure future implementation maximises patient and system benefit.

  • Value for money will be identifying elements that can drive care hub models and similar models at scale to maximise benefits for patients and systems.

Our Urgent and Emergency Care theme is also collaborating with West Midlands AHSN and ARC, who are also evaluating models of unscheduled care in the community (Acute assessment and medical care without hospital transfer for older people living with frailty), to identify and document synergies within the two care models.

This exciting project promises to deliver rapid evidence to inform the future development of models of unscheduled care in the community, at a crucial time as we emerge from the pandemic and NHS services and staff attempt to build resilience in to the recovery.

For further information on this work please contact Colin O’Keeffe on c.okeeffe@sheffield.ac.uk.