LAUSR

Introduction The Improving Adult respiratory Care Together (ImpACT+) project is a collaboratively designed, commissioned integrated respiratory service in South Derbyshire which was fully implemented in July 2018. This comprehensive service was evidenced based, follows NICE recommendations and included components based on service-user feedback. The service spans prevention through to end of life, includes all respiratory diseases and utilises learning from the asthma ImpACT project.1 Respiratory RightCare Commissioning for Value highlighted opportunities to reduce variation in non-elective admissions and this formed our primary objective. Methods We assessed the usage of the ImpACT+ service, outcomes of the virtual MDTs and the effect on non-elective admissions to the Royal Derby Hospital. The service fully launched in July 2018 in South Derbyshire, with a catchment population of approximately 660,000. It is delivered by a multi-disciplinary team (including consultants, specialist nurses, physiotherapists, occupational therapists, physical trainers and administrators). The 6 main areas are i) prevention ii) case finding iii) early specialist review at the point of diagnosis iv) on-going care including virtual place based consultant led clinics and pulmonary rehabilitation; v) crisis: telephone helpline and supported discharge vi) advanced care. Results Since the service launched, we received 4932 referrals. The telephone helpline received 493 calls, directly avoiding 14 admissions. 207 patients were discussed in the virtual respiratory clinics, avoiding 83 referrals to secondary care (40%). Other outcomes from the virtual clinics included medication changes (23%), pulmonary rehabilitation referral (25%) and confirmation of new diagnosis (20%). Since introduction, non-elective admissions for all respiratory conditions have declined by 6% (7563 in 2017/18 to 7110 in 2018/19). COPD non-elective admissions fell 4% (1132 to 1086), asthma non-elective admissions dropped 16% (456 to 381). Emergency department attendances for asthma dropped 9% (639 to 584) during this period. Figure 1 shows the trend of asthma and COPD admissions since 2015. Conclusion Within one year of launching an integrated respiratory service, we have demonstrated that the service is well utilised and is associated with a reduction in non-elective respiratory admissions and emergency department asthma attendances. Reference Subramanian D, et al. P197|The improving asthma care together (impact) project. Thorax 2017;72:A189–A191.Abstract P170 Figure 1 Non-elective asthma and COPD admissions since 2015