Abstract Background The Ageing Well Strategy within the NHS Long term plan established UCR services to meet the needs of older people in frailty crisis within 2 hours of referral. UCR services will be critical to meet the ambitions laid out in the NHS 10-year plan and will need to be more integrated with wider frailty pathways, both through Neighbourhood Health care and with acute hospital-based services. UCR 2-hour performance deteriorated over several months and variation in knowledge and skills were identified. A rapid improvement approach was used to transform the service using QI methodology. Methods A3 QI methodology was used to underpin rapid improvement over a 6-week period, including: An ‘understand’ phase: Detailed process mapping Fishbone to categorise multifactorial problems. Baseline performance data: Benchmarking each staff member against the core capabilities for frailty and the core capabilities for UCR/Virtual Wards. Capturing staff experience through an emotional map using experience-based design. Creating a vision for a fully integrated UCR service with all staff having the knowledge, skills and competencies to deliver a safe effective service for older people with frailty. Rapid improvement over 6 weeks including: Daily PDCA and twice daily improvement huddles testing change daily. Use of standard work for handover, board rounds, staff allocation. Use of visual management. Creation of new roles including a clinician in charge and enhanced clinical practitioner. Co-location of clinician in charge and board rounds with single point of access and H@H Bespoke education and training and development plan for each staff member against the core capabilities. Results UCR performance measures: The 2 hour standard for UCR intervention fell to an average of 56.5% per month between January and April 2024 (range 46–68). Following the rapid improvement programme this improved to 81.3% in May 2024 and has been sustained over 12 months with an average of 83.77% per month (range 78.9–87.3%). The proportion of referrals allocated to 2 hour response improved from 35% to 65% and this was sustained over the 12 month period. Quality Improvement skills: 50% had QI basics training improved from 50% to 100%. 0% had QI practitioner training, with 3 staff members completing this in the following 6 months. UCR core capabilities: 50% met tier 2 standards, with development plans initiated. 20% had completed relevant level 7 modules, with training needs assessment completed in addition to creating an Enhanced Clinical Practitioner (ECP) role. 80% have now completed health assessment modules and 4 have transitioned to an ECP role. Frailty core capabilities: Tier 1 training improved from 71% to 100%. 14% were tier 2 trained, with development plans initiated. 0% were tier 3 trained, with workforce modelling initiated to move staff to an ECP role. Conclusions A rapid improvement approach using QI methodology can be used to transform complex multifactorial problems in a UCR service. Not only can this improve assessment within 2 hours of referral for older people in frailty crisis, it could lead to sustained performance through shifting the culture from a 2 day response to a 2 hour responsive service. When augmented by an education, training and workforce development plan, this can lead to lasting change and create a safe, effective, efficient UCR service.
Adams et al. (Sun,) studied this question.