Implementation of the ‘Cardiff
data sharing’ model in Derby
City:
2010 - 2013
Derby: 2008
• Derby Second worst in East Midlands for alcohol-related
hospital admissions
• 22nd worst Local Authority in England
• Rate of increase in alcohol admissions between years of 23%
- against a national average of 11%
• 66% greater rate of admission than East Midlands and
England
• 6000 dependent drinkers; 33,000 binge drinkers; 9,000
harmful drinkers
• 2008/9 - 2,710 alcohol related crimes reported in the City
See: Quarterly rate of alcohol-related admissions per 100,000 population (EASR)
Derby: 2010
• New alcohol treatment system introduced at a cost of £1.6
million a year
• Derby’s model commended for excellence by the
Department of Health
However….
• £3.1 million still spent on alcohol related A&E interventions
• £10.9 million spent on alcohol inpatient activity
• £2.9 million wholly attributable to drinking
• Failure to fully implement Cardiff approach in Derby City –
despite stakeholder engagement and detailed planning
Assaults – Knowledge/reporting
Targeted policing
Licensing
POLICE
Environmental health
CCTV
EMERGENCY
25% DEPARTMENT
Identification of hot-spots early
The ‘Cardiff Model’
Original approach developed by Prof. John Sheppard – in Cardiff
Emergency Department reception staff collected a simple data set:
• Location of assault
• Date / Time of assault
• Weapon Used
Anonymous, monthly sharing of this data with CSP (then forwarded to
Police for tasking)
Emergency Department Consultant was chair of local CDRP/CSP board
Derby’s Cardiff approach 2010
• Developed information sharing agreement between CSP,
Police & Acute Trust - utilise former Cardiff model template
• Modified EDIS (Hospital data recording system) based on
Royal College of Emergency Medicine best practice – to
include four alcohol related admissions & situational
questions
• Agreed to export data into the data warehouse on a
fortnightly basis – with onward push to CSP
• CSP were to analyse and sanitise data, forward on to county
and Police
Example of data collected - Addenbrookes
Day
Post code
Date
Time
Age
Sex
Location
Disposal
Saturday
CB2 7
31/01/2009
09:10
42
Male
MILL ROAD
DOP
Saturday
SG1 4
31/01/2009
03:33
25
Male
OUTSIDE H+M CITY C
DNW
Saturday
PE2 5
31/01/2009
03:39
32
Male
FOUNTAIN CAMBRIDGE
DGP
Sunday
CB2 7
11/10/2009
01:30
18
Male
OUTSIDE BALLARE
DIS
Sunday
PE2 7
11/10/2009
04:08
19
Male
ROSE CRESCENT
DIS
Sunday
CB2 7
11/10/2009
05:34
44
Male
LEISURE PARK
DIS
Sunday
CB4 8
11/10/2009
08:10
21
Male
REFUSED TO SAY
DIS
Sunday
CB2 7
11/10/2009
11:21
20
Male
OUTSIDE BALLARE
M5
Sunday
CB1 2
01/02/2009
00:54
18
Male
BALLARE
DOP
Derby: 2012/13
• Number of alcohol related admissions fallen from 2,125 to
1,375. A -14% decrease
• English national average showed an increase of 4%
• Derby among England’s top 5 local authorities for minimal
alcohol harm
• Between 2009 and 2011 there was an 184% increase in the
numbers receiving community alcohol treatment
• Increase in percentage of successful treatment exits from
42% to 69%
Derby re-launch: 2012/13
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A re-launch of the Cardiff data collection model will take place over early 2013. Staff
will be re-engaged by senior ED managers
RDH to identify ‘nurse champions’ to work on embedding the concept of the Cardiff
model with nursing and reception staff
Visibility for the scheme will be increased at the hospital using posters displayed
across the hospital outlining why the alcohol related questions are being asked
A generic alcohol video to be played in the ED waiting room at appropriate times
DAAT to sponsor an incentive scheme/competition for ED reception staff, whereby
staff will be rewarded for the number of competed data sets recorded on a quarterly
basis
RDH to work through the practical difficulties previously encountered such as:
sensitivity of receptionist to asking alcohol questions; the level of information
ascertained at triage; the involvement of IT managers in the process; and the extent of
the previous modifications to the EDIS system
A dedicated police inspector will be identified to offer the necessary links between the
Cardiff approach and on street policing results
CNP will provide feedback information to ED staff (a bulletin) detailing how the
information has been used by the police and the resulting police action
Police Expectations
• Less is more
• Aim to collect a few items about
a lot of people
• Location / Date & Time of
Assault / Weapon used
• There is no obligation for
Emergency Departments to do
this
• Ethnicity of perpetrator
• Number of perpetrators
• Where alcohol had been bought
prior to the assault?
• Name of perpetrator?
• Domestic assault?
• Police aware of the incident?
• GPS location of assault
• Type of alcohol consumed
• Amount of alcohol consumed
Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital
Police Expectations
• Less is more
• Aim to collect a few items about
a lot of people
• Location / Date & Time of
Assault / Weapon used
• There is no obligation for
Emergency Departments to do
this
• Ethnicity of perpetrator
• Number of perpetrators
• Where alcohol had been bought
prior to the assault?
• Name of perpetrator?
• Domestic assault?
• Police aware of the incident?
• GPS location of assault
• Type of alcohol consumed
• Amount of alcohol consumed
Governance
Hospital IT governance
• Onus is on the Police to use this data responsibly.
• Crime prevention rather than crime detection.
• Information Commissioner’s Office opinion
Barriers from Health
• No ‘Command and Control’ structure.
• Injury management versus injury prevention.
• Data protection concerns.
• No meaningful incentive.
• Silo mentality
Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital
Aiding Implementation
What Works
What doesn’t work
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Persistence and Relationships
Local Champions
Safety Awards
CQUINS
Commissioning
Violence Reduction Nurses
Confrontation
Insisting
Negative Feedback
Scope-creep
Dr Adrian Boyle MD FCEM - Consultant in Emergency Medicine, Addenbrooke's Hospital
Derby: 2013 – story so far
• Irrespective, alcohol related crimes have reduced from 2,710
in 2008/9 to 765 in 2012/13
So far not particularly good….
• Some Cardiff data has come through from RDH to PH/CNP
since early 2013
• Data quality is sketchy and numbers being recorded are very
low
• 12 months of historical archived data was also forward for
analysis – data quality made this difficult
• Examine the situation in 12 months time
Next steps
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Training of ED receptionist – what to ask and why?
Further awareness raising of scheme at RDH
Police and senior management visits to ED
Alcohol packs for ED to reinforce the HALT/RAID and Cardiff
data collection