Step Up Care

What was the issue you were addressing or working on?

Annan is a small market town with the acute hospital 16 miles away.  Feedback from local
peoples stated if they were unwell they wished to stay as close to home as possible.  The issues were:

  • Avoiding unnecessary admission to the acute setting
  • Effective utilisation of local resources
  • Providing Services Closer to home
  • Taking a person centred approach to care

What you did?

The test involved local GP’s admitting patients to a local care home as a “step up facility” for up to three days, as an alternative to an acute hospital admission.  This care was for individuals who were over 65, and had a physical illness which did not require invasive therapy.  Individuals were identified by the GP’s following a home visit.

The test of change was carried out over a 6 week period from 27 May 2013 until 8 July 2013.  Prior to the test commencing, the partnership of two GP practices, District Nursing team, Care Home team, Out of Hours and the Scottish Ambulance Service developed a care pathway.  This was then implemented.  Over the six week period four individuals used the step up facility.  The care home staff implemented  Modified Early Warning Score and Community Respiratory Early Warning Score charts to give senior carers an early warning guide if the patient’s condition was to deteriorate and  what action to take if it did. This test was supported by the Change Fund.


What were the outcomes - benefits or otherwise?

  • Patients cared for in their hometown, more relaxed and less stressful experience.
  • Easier for relatives and Carers to visit
  • Able to utilise local facilities and resources more effectively
  • All patients/relatives reported their care as a very positive experience.

Potential financial returns as cost per night were less than in the acute setting


Contacts - to find out more

Dr Neil Kelly nkelly@nhs.net

Donna Wallace, PYF Community Staff Nurse, 07736086156