McKesson’s InterQual clinical decision support software is being deployed across the East Midlands to identify patients who can be treated outside of acute settings.

The results of a ‘utilisation review programme’ run in NHS Nottinghamshire County in reducing unused community hospital beds and providing more care in the community have led to its being extended across the region.

Head of pathways and improvement at Nottingham North and East Clinical Commissioning Group, Fiona Callaghan, said work began at the Nottinghamshire County primary care trust in 2010 to assess how patients were using health services.

“It had become clear that if we didn’t tackle the critical levels of unplanned admissions into our acute trusts, the service wasn’t going to be affordable in the future,” she said.

The PCT worked with East Midlands Procurement and Commissioning Transformation – an NHS service set up to help commissioners to deliver performance improvements – to become one of the early implementers of its utilisation review programme.

The programme deploys InterQual clinical decision support software to indicate whether a patient’s admission into hospital and their length of stay is appropriate for their condition.

“We wanted to establish two things,” said Callaghan. “How many patients were being treated in the hospital that could actually be treated in an alternative setting.

"And, for those that had been appropriately admitted, at what point should they go to an alternative level of care?”

The PCT and EMPACT conducted a series of ‘snapshot reviews’ of its acute trusts, focusing on admissions and continued stay, followed by a snapshot review of the region’s community hospitals.

The data revealed that in one of the trusts, 23% of inpatients did not warrant acute care at that time. It also highlighted that a number of patients could have been discharged earlier, or offered treatment in a community setting.

“We began to negotiate with our social care providers so that we could reduce the number of patients that were stuck in hospital awaiting the right social care package,” Callaghan said.

“We have since transformed the service to the extent that in the past three months we have had no delayed transfers of care from the community hospital.”

As a result of the programme, the community hospital has reduced the number of unused beds by 24. EMPACT has continued implementing snapshot reviews across the East Midlands.

EMPACT director of commissioning services Peter Huskinson said: “Our snapshot utilisation reviews have resulted in aligning services and delivering more efficient services and savings, whilst still ensuring best practice and high-quality patient-centred care is maintained."