In the driving seat

A physio is among those involved in a project that is using computer software to help ensure patients receive the care they need, in the right place at the right time. Daloni Carlisle reports

A physiotherapist has been appointed as a case manager in the first UK trial of a computer system that helps to assess whether patients are in the appropriate place for the care they need. Physio Liz Cowley took up the role of case manager at Rotherham General hospital in May this year and now works on a general medical ward assessing whether patients are ready for discharge, and if so, helping to make sure this is done safely. She is using a computer tool called InterQual, developed by US computer giant McKesson and in use in over 5,000 settings worldwide. Senior clinicians use the system to assess patients’ symptoms against an evidence base of over 16,000 citations to decide what level of care they need. Rotherham trust is now working with McKesson, Rotherham Community Health Services and the local council to test InterQual in the NHS. McKesson hope it will help the NHS address a core issue of making best use of resources by treating patients in the right place at the right time. It is being used in the acute hospital and in the community, where it can help identify people who need more support to stay at home or need admission to hospital. Anonymised assessments can also be aggregated and used for management information. CASE MANAGER ROLE Carole Lavelle, project lead at the acute trust, says that in the US critical care nurses carried out the case manager role, but she felt physios and occupational therapists would be well suited in the NHS. ‘The main focus of the case manager role is to facilitate the patient journey and help move away from episodic care. It does not need a nurse. It needs someone with clinical experience and clinical expertise.’ Ms Cowley told Frontline that her new role was very different from a traditional physio role and very challenging. She says: ‘I am interested in the bigger picture of clinical care such as service development and length of stay and how they impact on quality of care.’ InterQual is now in use in four wards in the hospital, with more due to start this summer. Over 3,000 assessments have been completed. Case managers, who also include nurses and an occupational therapist, have found that up to 80 per cent of the patients they assessed should not be on an acute ward, although they were selecting the patients most likely to be ready for discharge. INFORMATION PROVIDES EVIDENCE Jackie Bird, director of nursing at Rotherham, says the InterQual assessments are providing managers with useful information about bottlenecks in the service. She says: ‘Our problem as an acute trust is that we are not getting the flow of patients out of the hospital and we believe this is because we do not have the right level of care outside in the community.’ InterQual assessments have provided evidence of this and are now being used to develop a business case for a 20-bed rehab ward. Ms Cowley adds: ‘As case managers we feel like we are driving change. We are collecting data and each day we are closer to getting the care that patients need in the appropriate place.’
Daloni Carlisle

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