Identifying high cost patients
A local practice identified, using RAIDR’s Secondary Care dashboard, a significant frequent user to A&E that they were unaware of. They located the patients records on the clinical system. They then reviewed the patient’s record, and begin the process of putting in place face-to-face appointments with the intention of establishing a mutually agreed care plan to reduce the attendance rates. The practice hopes that they will be able to reduce the attendance from 100 attendances per year to less than 25. RAIDR estimated that the cost of attendance was around £85k per year at current levels, so the practice predicts the doing the above could reduce costs by around £50k per year if proposed plans were put in place.
Identifying high risk patients
RAIDR flagged that a practice with an older demographic had a significantly higher risk of falls/ fracture risk for their population than other practices in the CCG. Despite the practice believing that they managed the older element of their population well, RAIDR highlighted that a number of key elements such as lead GP and care plans were not in place for a large number of their highest risk patients. Using the RAIDR Primary Care dashboard the practice were able to identify the population that needed intervention, with access to the patient NHS number the GPs were able to review patients and establish care plans where appropriate therefore improving patient care and delivering cost saving for the practice.
Utilising RAIDR to investigate variation in spend
While looking into variation on spend across their GP practices a CCG identified one small practice with an exceptionally high spend per head on inpatient spells. Using RAIDR’s Secondary Care dashboard to investigate they found a surprisingly high cost attached to one patient, with a zero day length of stay, cost of £58k and a primary procedure of E423 - Temporary Tracheostomy. This led them to search for all patients with the same diagnosis across their local CCGs. There were a small but significant number of patients across different practices with the same primary procedure some with zero day length of stay but also some with long lengths of stay both with very high costs attached. More in-depth scrutiny found that patients admitted as emergencies to Critical Care would be shown with zero days stay, however the cost would be worked out according to the spell start and end dates. Using RAIDR to identify the above the CCG were able to understand the reasons for the variation and share their learning with other CCGs.
Analysis of frequent calls to 111 to identify vulnerable patients
Practice Manager utilised the secondary care dashboard to identify 111 frequent callers and identified a patient that was calling frequently, upon investigation the PM discovered that patient was a new mother that was struggling and was in need of some assistance, the PM worked with the health visitor and the nurses within the practice to ensure that the patient was supported by the surgery and the community and was no longer calling 111 for support.
Using Secondary care to identify vulnerable patients
The secondary care dashboard has been particularly useful for the practice we collected data from RAIDR which showed that there were 3 patients from the practice who had more than 10 contacts with Out of Hours services (OOH) in a 3 monthly period. One patient was the child of an anxious parent who also attends A&E on a regular basis. As a result of identifying this we discussed in our GP practice meeting, also discussed OOH contacts in Safeguarding team and the Health visitor was aware and arranged a visit to address mum’s anxiety issues. As a result of the above interaction awareness was raised within the practice of the patients ongoing anxiety issues. Patient plan was put in place for both child and mother to highlight the issues along with ongoing support from the health visitor – working together with local community for benefit of the patient.
Example of how a Practice manager uses the daily urgent care dashboard to benefit a busy practice
Our practice uses the RAIDR Urgent Care Dashboard on a regular basis to help monitor all of our patient’s admissions and discharges. It’s an easy way to review all of our patients and it ensures that we don’t miss a patient that would benefit from a review at the surgery. We no longer have to rely on receipt of the discharge summary from the hospitals, which are often received late, and with all this information at our fingertips we can make early contact with a patient to address potential issues. This could easily avoid further admissions to hospital.
Example of Demand management team leader utilising RAIDR to support practices
I use RAIDR daily, mainly the Secondary Care dashboard to collect activity data for all of our CCG practices. For example, last week I did an audit for a practice that had been identified as having high emergency admissions for one specific specialty. The same practice requested a review of A&E and Urgent care frequent users and again I used the secondary care dashboard to identify the patients for the practice to review. The information is easily extracted, is available as I need it and saves time by not having to make repeated requests to an already busy information team. It helps to identify areas where savings can be made and where patient care can be improved. I usually log into RAIDR in the morning and use it throughout the day.
Enterprise Case Study: Democratising Insights in the NHS
Ovum is a market-leading research and consulting business focused on converging IT, telecoms and media markets.
In the summer of 2015, they independantly examined RAIDR's development, differentiation, impact, and road map in the context of healthcare improvement and analytics best practice.
Their findings are published in this downloadable PDF document, which includes detailed analysis of RAIDR's growth and success.
RAIDR enables patients who potentially have dementia to be identified. The dementia case finding tool identifies patients with a dementia diagnosis in secondary care but no diagnosis in primary care; and also patients who have anti-dementia drugs prescribed but no diagnosis of dementia recorded on their GP records. The case finder will play a part in meeting the needs of the growing number of patients suffering with dementia as well as ensuring such patients are included for QOF prevalence payments. The tool also supports practices with the National Dementia Diagnosis Improvement programme work.
One of our GP practices identified through our dashboards, that a patient was being prescribed drugs for epilepsy although this condition was not recorded for that patient on their GP Clinical System. The identification of the above highlighted that not only was this patient not included for QOF prevalence payments, but more importantly the patient may not be receiving the appropriate level of care for his condition.
RAIDR enabled a GP practice to identify a particular patient who had a high number of A&E attendances. Further investigation revealed that the patient had initially visited A&E with a severe migraine and had then continued to return to A&E to receive treatment for subsequent migraines. These visits totalled 35 within one financial year. As a result of obtaining this information the practice was able to signpost the patient to a more appropriate care pathway greatly benefitting the patient and resulting in a reduction in healthcare costs.
Our customers have highlighted that one of the benefits of RAIDR is the ability to enable GP practices to identify opportunities to maximise their budgets through the identification and investigation of high cost inpatient spells and frequent A&E users. For example RAIDR enabled a GP Practice Manager to identify one of their patients who had an inpatient stay in hospital of 366 days, equating to a cost of £90,000. Through further investigation the Practice Manager was able to identify that an incorrect discharge date had been recorded for the patient, this exercise made almost £90,000 difference to the practices’ financial outturn. The above highlights the power of RAIDR – enabling our practices to have self-service access to data to avoid any costly data quality issues.
Fracture Risk Tool
The NECS Fracture Risk Tool is part of the well-established NECS RAIDR Business Intelligence Tool that enables GPs and other care providers to view clinical and patient information. This helps decision making and promotes better case finding, that in turn improves patient outcomes and reduces overall health care costs.