ImpACT+ (Improving adult respiratory care together) - South Derbyshire
Project overview, including who was involved in the project
The ImpACT+ service started in 2018 to proactively manage people at risk of developing, or who have a diagnosis of respiratory disease, via the provision of a neighbourhood place based holistic approach to care. The service supports patients with respiratory diseases including COPD.The service aims are to:
• Support the early diagnosis of respiratory disease, in particular COPD and asthma.
• Support the on-going care of people with a confirmed diagnosis of respiratory disease via a Multi-Disciplinary Team (MDT) approach to holistic care planning, education, appropriate prescribing, and co-ordination of care inclusive of pulmonary rehabilitation (PR) and home oxygen assessments.
• Support the early identification, and on-going needs of people with advanced stage respiratory disease.
• Reduce admission avoidance, with respiratory patients managed in the community/their own homes, i.e., patients with exacerbating symptoms.
The components of the service include:
• Neighbourhood MDTs - A lead respiratory nurse is allocated to each place/neighbourhood and work with practices to identify patients who would benefit from a holistic respiratory review and input for one or more of our services. MDTs in each neighbourhood are undertaken with the input of a respiratory consultant with access to primary care records.
• Complex MDT
• Lung line access to a specialist nurse
• PR - a rolling programme with multiple venues across the region.
• Home Oxygen, including ability to check blood gas analysis in the patient’s home
• Fatigue and breathlessness groups - to provided holistic support and education to patients and cares
• Education sessions
• Lungs 4 life peer support group
• Smoking cessation referrals
Who was involved in this work/project?
- University Hospitals Derby and Burton
- NHS Derby and Derbyshire Integrated Care Board (ICB) / Joined Up Care Derbyshire
Project outcomes/impact
In September 2020 the ImpACT+ service won a HSJ Value Award for the Respiratory Care Initiative of the Year.In the first 5 years of the service, outcomes have included:
• Neighbourhood MDTs - Over 2600 cases have been discussed with a focus on confirmation of diagnosis and managing their long-term condition.
• Complex MDT - Over 3000 patients discussed including patients after admission for an exacerbation of COPD
• Lung line - 5723 calls into the service, 90% of which were from patient and carers, 9.3% were from Primary Care and 0.7% from the Ambulance services. 81% received advice and 12% were reviewed face to face, 5% were advised to contact their GP, 2% of patients were advised to attend ED.
• Pulmonary rehabilitation - 5611 patients referred with a completion rate of 69%.
• 85% of patients demonstrated improvements in walking distance/exercise capacity at discharge from programme.
• Home Oxygen - 2471 patients with 100% of these patients having an annual review.
• Fatigue and breathlessness groups - 445 patient accessed the group.
• Education sessions - 21 education sessions including education on LVRS, oxygen and palliative breathlessness management.
• Lungs 4 life - 329 patients have accessed this group.
• Smoking cessation referrals - More than 2000 referrals into these services
• Patient satisfaction survey - 99.6% of people reported a positive experience of the service
• Admission data shows an overall decrease (22%) in respiratory related non-elective admission. COPD admission dropped by 24% and asthma by 35% over the 5-year period of analysis. The lung line is assumed to have reduced urgent care contacts. Collectively, calculations by the ICB have shown significant cost avoidance following the implementation of this integrated respiratory service.
If you were to run the project again, what would you do differently?
• Have a health care professional working in primary care practitioner as part of our leadership team.• Include service users in our regular team meetings.
• To have a clinical psychologist as part of the team.
Advice you would have for others undertaking the same type of project.
• Work collaboratively with ICB commissioners to design the service.• Develop a patient-centred vision with input from all relevant stakeholders.
• There are significant benefits to bringing multiple services, which may be working in silo, into a single integrated team.
• Engage both primary and secondary care to develop a service with is useful and of mutual benefit.