promoting the benefits of cardiac rehabilitation

EMPACT and the Cardiac and Stroke Network (CSN) have been working together to promote the benefits of the national Cardiac Rehabilitation Commissioning packs across the East Midlands. Good cardiac rehabilitation (CR) involves a comprehensive assessment, ideally by multi-disciplinary teams, followed by a full care plan, involving medication, therapy and lifestyle advice.
The first phase of this key EMPACT/CSN project is now complete. The market development team has worked with the CSN to carry out a full regional market assessment using local evidence to understand what uptake rates are, what will be required to increase them, and where increases should take place. Coronary heart disease is the most common cause of premature death in the UK, accounting for almost half of all cardiovascular disease deaths.

Further adoption of cardiac rehabilitation has been shown to reduce re-admissions, lower the risk of secondary cardiac events, improve overall patient satisfaction, and produce cost savings. However, current uptake rates in the East Midlands vary – and in some areas they are as low as a third of all patients who have suffered cardiac episodes.
Issues to overcome include low patient awareness, a shortage of clinical capacity in some areas, variations in specifications for rehabilitation services and lack of investment in CR. We are now developing with CSN an East Midlands model for CR to iron out unwanted variations and promote better awareness among patients and commissioners of the benefits good CR can bring.

Work is progressing on rationalising the transport services which give eligible patients NHS-funded journeys to and from non-emergency treatment. Invitations have gone out to suitably qualified transport organisations to bid for a five-year contract for the East Midlands. Estimates across the region show that more than a million such patient journeys are made a year in connection with treatment, mostly outpatient appointments. Although they are free to eligible patients, the real cost to the NHS is just over £20 a trip. And more than 250,000 journeys were booked then cancelled – or were started and abandoned because they were not needed – wasting NHS staff time and resources.

These transport contracts vary across the East Midlands, with some areas using voluntary car services, which may not always be able to meet demand due to strict limits on drivers' hours. Booking arrangements also vary, and so do the ways in which patients are checked before being allowed free transport. These patient transport service contracts had not been reviewed for several years, until the East Midlands' NHS chief executives asked EMPACT to examine the regional picture and suggest solutions. Standard eligibility criteria for transport were issued across the region in April this year. Now a revised service contract has been put out to tender and it is hoped an agreement will be reached by October 2011, with a view to starting the new services from April 2012. The new service will have core elements shared across the region, with room for local variations in each county.

re-admissions, acute invoices, maternity pathways analysed

The latest information to go onto EMPACT's Commissioning Information System (CIS) includes updated reports on the first months rates of hospital re-admission within 30 days of discharge. The updates include the emergency re-admission reports, along with a summary guidance sheet to assist in interpreting the data provided. Also available on CIS is the suite of 'acute invoice validation' (AIV) reports for April 2011 hospital activity, in a 'pseudonymised' format to protect patient identification. AIV reports are published monthly in line with national timetables to support the financial management of contracts.

A maternity pathway benchmarking analysis has also been uploaded to CIS offering additional intelligence for commissioners and providers to help them get the best outcomes for the most effective pathway across maternity services. The report finds there is a high degree of variation in the cost of maternity pathways within the East Midlands. There is also variation in maternity performance outcomes and quality indicators across the region. However, there is no obvious link between this variation and the differences in pathway spend for each provider.

EMPACT is working with Royal Derby Hospital to use InterQual®, a utilisation review (UR) software tool to continually monitor day-to-day admissions, care and discharge.

In the first EMPACT programme of its kind, we have trained seven hospital staff to use the McKesson review tool to assess whether the right care is being provided in the right place at the right time.

This approach is called an 'embedded programme', and provides a longer-term assessment of bed use and care than the regular 'snapshot review' visits undertaken by our UR team at many East Midlands hospitals.

The first phase of the Royal Derby Hospital embedded programme involved working with the newly trained reviewers to undertake a snapshot review together.

To illustrate the versatility and benefits of the system, the combined team undertook 168 reviews of unplanned admissions, which included urgent and emergency cases. A further 168 patients had a continued stay review as part of the initial study. The output from the first phase has been a report of the findings plus an identification of other clinical areas in which to use the tool.

Future possibilities include embedding the UR tool along certain clinical pathways, such as stroke, fractured neck or femur or frail elderly.

The latest phase of the Derby project involves the hospital installing an interface between their patient admission system and InterQual® to enable ongoing monitoring and assessments.

As well as being improved visually, EMPACT Connect now has a guest access homepage, meaning that anybody on the NHS network can view the basic elements of the site before requesting access to the rest.

Connect has been developed as a central location for teams across the East Midlands to access and share important information. It's an online library of key knowledge for commissioners. Apart from being a great aid to commissioning, Connect offers a secure, region-wide forum for a growing number of users.

Already boasting numerous libraries containing hundreds of documents to be accessed and downloaded, Connect is constantly being updated with relevant and useful information. Featuring an advanced search facility, users are able to locate the document they are looking for with minimum effort. Enter a keyword, and narrow down the results by selecting different tags, including year, location and document type.

Recent additions include a new national care home contract, and service specifications for a community diabetes service. If you are working on a new diabetes pathway project, for instance, simply type in 'diabetes' to see a range of documents which may provide the answers you are looking for.

Want to get Connected? See Connect for yourself here: http://connect.empact.nhs.uk/Pages/Default.aspx. Request your own login by visiting the 'Need a login?' section, or by emailing the Connect Administrator at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

For more information on any of the items above please contact Corporate Business Manager, Cat Hase on This e-mail address is being protected from spambots. You need JavaScript enabled to view it   or on 01332 813391, who will ensure your enquiry is handled by the relevant project lead.