1. Helen Lingham – Chief Operating Officer Gill Adamson – Director of Nursing and Operations

2. Context In 2012/13 20% of first attendances at EDs across England were patients 65yrs+ (3.6million) This older group of patients are at higher risk of conversion to hospital admission Actively managing the first 72 hours of admission is critical in terms of rapidly establishing; an accurate initial decision to admit a differential diagnosis a clear management plan, including discharge (RCP Future Hospitals 2013). Hospitalisation of older patients results in deconditioning loss of independence and a reduced likelihood that they will be discharged home. ‘Hospital at home’ for selected patients offers significant advantages in terms of lower mortality and reduced functional decline.

3. UHNM – Our Aims for Frailty Patients  To improve patient outcomes and patient experience  To proactively manage the patients in the right environment with the right team, reducing the need for further transitions of care.  To minimise delays in management of care that increase LoS and associated deconditioning of patients  As a system to reduce conversion to bed stays Sub-acute care can and must be managed within community resources. The solution may be to avoid admission altogether or seek proactive ways to manage frail older people within the acute setting (Thompson et al, 2015).

4. The term stranded patient describes hospital in patients 70yrs and over with a 10 day or more LOS Stranded Patients

5. Assess before admission, Assess before admission, Todays work today and Todays work today and Discharge to assess (Home First) Discharge to assess (Home First) Simply put, this gives a framework to only treat people in hospital who need to receive that care in hospital.

6. Exemplar Front Door – Assess Before Admission What is it? A small MDT with a primary care focus, to target older patients presenting to the ED with multiple co-morbidities and to provide suitable alternatives to hospital admission. What do they do? Assess patients as early as possible upon presentation signposting to appropriate services as an alternate to admission What are the outputs? Avoid unnecessary admissions Providing support to returning patients to their usual place of residence (Home First) Building confidence in the services available outside the acute trust

7. Exemplar Ward – Todays Work Today Tools Red & Green Tool Establish the local exemplar ward team SAFER bundle principles and audit Best Practice Board Round Patient Questions –What is wrong with me or what are you trying to find out? –What is going to happen now, today and tomorrow? –What do I need to achieve to go home? –When am I going home? Issues; signposting and escalation Effective Discharge Principles of Exemplar are: Home First Avoiding delays Working in partnership Principles of Exemplar are: Home First Avoiding delays Working in partnership

8. Discharge to Assess Once patients no longer require acute medical care they do not need to stay in hospital Functional assessment for on-going support can take place in a patients usual place of residence The Home First principle describes the default option going ‘home’ to the usual place of residence with lowest dependency  10 days in hospital leads to the equivalent of 10 years ageing in the muscles of people over 80 (Giles et al, 2004).  There are around 200 medically fit patients at any one time awaiting discharge from UHNM

9. Better communications Earlier dialogue- keeping you updated throughout the stay Providing accurate information regarding patients condition, functionality Support post discharge?

10. Over to you…