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Dashboard data

Dashboard data

Insight: dashboards
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The Urgent Care Clinical Dashboard has grown from an experiment in a few Bolton GP practices into a phenomenon spreading across England and is now live in more than a thousand GP practices.

When current projects are fully implemented, this will increase to more than 2000 GP practices, covering a patient population of 13.5 million.

The dashboard enables GP practices to see timely information on their patients’ urgent care attendances, and thus to be more proactive in managing their care.

This in turn has helped to reduce A&E attendances and non-elective admissions.

The dashboard has been featured in publications by the King’s Fund, the Primary Care Foundation and the Royal College of General Practitioners as a way to support GP commissioning and improvement to local service delivery.

Concept

The Urgent Care Clinical Dashboard is a web-based application that can be accessed by GP practice staff on their desktop.

It collates the previous day’s activity data from A&E, hospital admissions, discharges, and other local unscheduled care settings and brings it all together in a user-friendly interface showing a summary view of the practice’s urgent care activity, usually for one day, seven days and thirty days.

Clinicians can click on the dashboard’s display and drill down to a detailed patient-level view, for example showing the symptoms a patient is presented with, and the outcome. This source of information on a GP practice’s unscheduled care activity is easy to access, easy to understand, and timely.

A major strength of the dashboard concept is its flexibility; implementing organisations can use their existing resources, such as infrastructure (eg. data warehouses and web portals) and internal Information and IT teams, to create their dashboard, reducing costs and reliance on external support.

Each dashboard is locally developed and clinically led, and though most use similar metrics, they incorporate different features and functionality tailored to local needs.

Paul Whittingham, commissioning manager at NHS Tees explains: “Early on we could see the benefits of introducing a web based urgent care clinical dashboard. It’s a great way to combine a whole range of complex data which can be easily used.

“The urgent care dashboard also means that GP practices have access to vital real time information about urgent care activity in the area.”

Origin

The urgent care clinical dashboard started life in NHS Bolton in 2008, as part of a wider National Clinical Dashboards pilot that demonstrated the benefits of using business intelligence and dashboard solutions across a wide range of clinical settings.

During the initial proof of concept stage, led by Dr Anne Talbot, a small cohort of pilot GP practices quickly realised benefits such as improved and more targeted active case management and more proactive support and care.
Dr Talbot, referring to the increased visibility of unscheduled care activity, said: ‘When I first used the dashboard it was like suddenly having the blinkers taken off. It was a real eye opener.’

At Bolton it was found that the information provided by the dashboard could be used at different levels: firstly, to identify and manage the care of individual patients; at practice level, to identify issues regarding access to primary care; and at organisation level, to recognise poor patient pathways and training needs.

Within the first pilot practices in Bolton, one practice reduced their A&E attendance by 16.8%, compared to an increase of 3.85% in their peer practices.
A second practice reduced their non-elective admissions in targeted areas of asthma, COPD, diabetes, falls and heart failure by 20.69%.

The dashboard was also used for active case management in conjunction with the predictive risk model Patients at Risk of Re-hospitalisation (PARR++), and total average bed days for patients on the ACM caseload fell from 14.1 to 2.9.

These successes led to the dashboard pilot extending throughout NHS Bolton.
Since 2008, using the dashboard alongside other service improvement initiatives, A&E attendance at NHS Bolton has reduced year on year, and this now shows a 3% reduction from the 2008 baseline.

It was calculated that over the year 2009-2010 the reductions equated to efficiency savings of over £600,000.

Advances

In early 2011 the urgent care clinical dashboard project was initiated as part of the QIPP urgent and emergency care workstream, and applications were invited from NHS organisations interested in implementing their own dashboards.

A few months later, the first dashboards went live in their pilot practices. Thirty PCT/CCG areas, supported by a small central team, have now implemented a live urgent care clinical dashboard, and many of these have evolved beyond the scope of the original dashboard.

New features include integrated risk stratification scoring, alerting functionality to inform practices if a patient they have flagged has attended an urgent care setting, urgent care attendances displayed by time band, and yearly activity comparisons.

Another popular new feature is a pseudonymised organisation-wide view. This enables commissioning support staff to have access to the dashboard to identify trends, see typical pathways and to help identify patients that appear to need intervention without having access to the patient identifiable data.
In terms of cost, several sites only needed to purchase software, spending £6,000 or less on their whole implementation. For practices, which invested in additional staffing and/or software, the average total spend was £43,000.

As the dashboard increases visibility of patients’ urgent care activity, implementing organisations have found and shared many emergent benefits.
At a high level, practices can monitor trends in attendance and use this analysis to inform their planning.

Common uses of the dashboard include reviewing it in patient consultations, monitoring cohorts of patients (e.g. patients with COPD), reviewing caseloads and care plans with community matrons, informing GP peer reviews, following up patients with high attendance rates in urgent care settings and identifying opportunities for patient education.

Several organisations use the dashboard to inform their discharge planning. Other reported benefits include supporting earlier discharge, reduction in emergency admissions, and improved communication between teams. Some sites are also using their dashboards to begin to address variance in primary care, by comparing practice urgent care attendance rates to the consortia average.

To date the dashboards have received very positive reactions from clinical users, and when sites with live dashboards were surveyed, feedback was that all projects had either met or surpassed their objectives.

The Urgent Care Clinical Dashboard project aimed to build local dashboard capability and also to generate reusable tools and templates to facilitate further implementations.

Teams from live sites have generously shared their knowledge, experience and resources with newer implementers, and local support for organisations wishing to implement a dashboard is available via the Dashboard User Group, which holds regular virtual meetings and offers online help and support.

An implementation toolkit containing a project guide and other tools such as a logical implementation architecture, data-feed specifications, standard metrics, project management templates, and a costing calculator, is available on the dashboard NHS Networks site at www.networks.nhs.uk/nhs-networks/qipp-urgent-care-gp-dashboard.

The urgent care clinical dashboard project worked with the NHS Interoperability Toolkit (ITK) to develop the data-feed specifications which have been implemented by both TPP in SystmOne and by Advanced Health and Care in Adastra.

Liz Hedgecock, Urgent Care Clinical Dashboard National Co-ordinator, Department of Health. Jim Lewis, Technical Architect, Department of Health Informatics Directorate

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