3843 Two day culture in a two-hour world: transforming an urgent community response (UCR) service through quality improvement (QI)

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.