Care and support in a crisis
What is this and how does it work?
People at high risk of their personal health deteriorating are among those who benefit most from integrated care. They tend to be older, frail, and living with multiple chronic conditions. Despite the best efforts to coordinate their care in the community, their conditions can worsen and urgent needs arise. Unmet needs can quickly spiral into a crisis.
Crisis response services’ main goal is therefore to provide timely access to advice and treatment to prevent an escalation of needs that require emergency care and hospital admission.
Provision of crisis care encompasses a whole range of urgent and emergency services. Some services, such as NHS 111 and GP out-of-hours services, expand access to primary and community care, whilst others, such as 24/7 liaison mental health care or nurse-led rapid response teams, are services specifically designed to provide a rapid response of specialist clinical, mental health or social care support.
Explore care and support in a crisis
- Transforming urgent and emergency care services in England (NHSE et al. 2017)
- Integrated Urgent Care Service Specification (NHSE 2017)
- Achieving Better Access to 24/7 Urgent and Emergency Mental Health Care (NHSE & NICE 2016)
- Who knows best? Top tips for managing the crisis (HSMC 2016)
- London mental health crisis commissioning guide (NHS 2014)
Practice examples Open
- Gloucestershire - working with the fire and rescue service (NHSE Integrating better 2019)
- Rotherham integrated urgent and emergency care centre (LGA 2018)
- Moving healthcare closer to home case studies: admission avoidance/rapid response (Monitor 2015)
- Mental health and new models of care: lessons from the vanguards (King's Fund 2017)
- Making seven days work in emergency care The Northumbria Way (2016)
Measuring success Open
- Emergency hospital admissions in England: which may be avoidable and how? (Health Foundation 2018)
- Reducing emergency admissions (NAO 2018)
- The state of care in urgent primary care services (CQC 2018)
- The impact of integrated care for people with chronic conditions on hospital and emergency department utilization: a rapid review (Publisher, Year)
- What the evidence tells us about improving urgent care for older people (NHS Confederation 2016)
Latest evidence Open
These are the latest resources from Social Care Online, the UK’s largest database of care knowledge and research.
Pilot testing the detection of elder abuse through emergency care technicians (DETECT) screening tool: results from the DETECT pilot project
- Taylor and Francis, 2019
Understanding which people with dementia are at risk of inappropriate care and avoidable transitions to hospital near the end-of-life: a retrospective cohort study
- Oxford University Press, 2019
Know me – a new person-centered approach for dementia-friendly emergency department care
- Sage, 2019
Navigating and making sense of urgent and emergency care processes and provision
- Wiley, 2019
Immediate responses by service providers after a violent critical incident: a systematic review
- Elsevier, 2019
Reducing emergency department visits among older adults: a demonstration project evaluation of a low-intensity integrated care model
- Emerald, 2019
Social work intervention for women experiencing early pregnancy loss in the emergency department
- Taylor and Francis, 2019
Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities
- Royal College of General Practitioners, 2018
Evaluating the impact of integrated care on service utilization in serious mental illness
- Springer, 2018
Impact of early assessment and intervention by teams involving health and social care professionals in the emergency department: a systematic review
- Plos Publications, 2019
- Pilot testing the detection of elder abuse through emergency care technicians (DETECT) screening tool: results from the DETECT pilot project
How do crisis response services relate to integrated care?
Well-coordinated person-centred care plays a role in reducing the likelihood of a full-blown crisis and containing the demand for urgent and emergency services. When people’s care needs change and urgent care is needed, having the right services available is critical to receiving timely care, such as:
- information and advice to people who use services so they can access support urgently and know how to navigate the system
- a single point of access to make accessing urgent help easier
- extended hours at GP surgeries and with community nursing teams
- community-based rapid response teams that can be despatched to provide care to people with deteriorating conditions
- community pharmacy services that can respond to medication needs
- 24/7 liaison mental health services
- ambulatory emergency care services.
Acute care cannot always be avoided. An integrated approach to managing emergency care is suggested. A multidisciplinary assessment at hospital admission and again in relation to discharge planning can ensure the transition to post-hospital care back in the community is well-coordinated and supports recovery, rehabilitation and reablement.
What do crisis prevention and response services need in order to succeed?
Like the vision for integrated care, the foundations of an effective crisis prevention and response service require a whole-system perspective, where professionals and providers work in a coordinated and joined-up way. Some key ingredients include:
- targeted interventions for people at higher risk of entering a crisis and for ’frequent attenders’ of hospital emergency care
- a community-based, integrated response to a crisis, with a clear model of care and protocols
- improving information-sharing across social care and health providers in a crisis or following a crisis (shared care records, red bag schemes)
- a multidisciplinary approach, including embedding social care staff in A&E departments, and to support hospital discharge and admission
- establishing processes that link primary care and community teams before and after a crisis.
What is the evidence for outcomes and impact?
An integrated approach to urgent and emergency care is expected to produce:
- timely care at time of crisis in the right place
- reduction in emergency admissions
- consistent and better quality of care
- positive work-based culture for person-centred, safe and effective care
- improvements in health outcomes
- better use of resources