1. Unscheduled Care Forum September 4th, 2018
“The Benefits of FIT Teams Operating at the Front Door in Acute Hospitals”
Population Ageing
A success story, not a catastrophe
I’m going to talk to you about the FIT Team
Unscheduled Care Forum
September 4th, 2018
Paul Maloney
Occupational Therapy Manager
Beaumont Hospital

2. Future Demographics in North Dublin
53% of over 75’s admitted
By 2026 there will be a 44% increase in the population of North Dublin >65 years

3. FRAILTY & the Emergency Department
Liew found that length of stay in the
emergency department independently predicted inpatient length of stay
ED stay 4-8 hours increases inpatient length of stay by 1.3 days
ED stay >12 hours increases inpatient length of stay by 2.35 days
LiewD, LiewD, Kennedy M. Emergency Department Length of Stay Independently Predicts Inpatient Length of Stay.
MJA 2003; 179;
Thus the importance of our motto “every hour counts”

4. ↑26% presentations (n=800) to ED ≥65 years Q1 2015 vs Q1 2018
This is the context in which Beaumont operates and continues to do so
Beaumont choose to implement a therapy team Sept 21st 2015
Next few slides I’ll outline who the team is, what we do in ED and the impact that they’ve had on two fronts – avoiding unnecessary admissions to hospital but also to the patients that were admitted

5. What is FITT and what do we do?
Next few slides I’ll outline who the team is, what we do in ED and the impact that they’ve had on two fronts – avoiding unnecessary admissions to hospital but also to the patients that were admitted

6. FIT Team Physiotherapy OT SLT Pharmacy Social Work Dietetics
ED Doctor
‘Frailty Intervention Therapy Team’
ED Nurse
On-take team
We triage every patient over 75 in ED within core working hours
Verbal referrals between HSCP was agreed to minimise delays
Core working hours
8am-4pm
Mon-Fri
‘Every Hour Counts’

7. Transforming Our Practice
Dedicated ED HSCP service
Identification of “FRAIL”
Generating early referrals to HSCP’s
Early assessment of physical, cognitive and functional ability
Initiation of treatment on appropriate pathway
Rehabilitation and collaborative discharge planning commences on day 1
Primary Care/ICT Services
How do we screen for FRAILTY? Tool - multiple frailty tools ISAR not working, worked for us at the time
Measures added from the Kings Fund
Doesn’t matter what tool – identify frailty
Interdisciplinary working – added approx 1 WTE back into the team

8. Core working hours of the team
Most patients present during day, currently not 7/7
Shows huge productivity for the hours that we are there
Axillary services are not 7/7

9. 75% Frail
Age range 75 to 97 yrs , Mean 84 YRS
35% live alone
52% have no formal community supports
17% had no informal support
5.6% are primary carer for other person

10. Impact on admitted patients
Data Trends
Admission avoidance
Impact on admitted patients
LTC Conversion
What did we achieve

11. ≥75 yrs.: ED Presentations
↑15.8%

12. ≥ 75 years: % of ED patients remaining at home (1st Representation to ED)

13. ≥ 75 years: Cumulative Days at Home April 2014 vs April 2018
2698 days spent at home for April
↑11.7%
FITT Patients (April) :
13,479 days
Include no of patients seen by FITT (Dc -195)
Supported Dc is why patient s
Culture
32,376 days

14. ≥75 yrs.: ED Complexity (Manchester Triage System) April 2014 vs April 2018 (No.)
April 2014: 42% admitted
April 2018: 50% admitted
Why such an increase in the admission ratio – significant increase in complexity
Orange are acutely unwell – focus on orange

15. FITT beds/Specialist Geriatric Wards (SGW’s) Activity Jan-July (2016-2018)
↑ 31% Discharges
2016 vs 2018
↓ 1.3 % Bed days
2016 vs 2018
SGW 70 beds, intensive MDT
31% increase in Dc 2016 vs 2018
1/3% decrease in bed days

16. ≥75 years: LTC Conversion rate
55 Pt’s less listed for LTC Jan-July (-2.3%)
LTC bed approx €1400/week
Less patients are converting to LTC despite an increase of 31% in 75+ presentations
If conversion rate remained as is in 2015 – extra 55 patients Jan-June (9 per month)
More patients remaining at home and cost savings to the state
Jan-June 2015
LTC conversion
= 9.4%
↑31% presentations (n=1117) to ED ≥75 years
Jan-June 2015 vs Q1 2018
Jan-June 2018
LTC conversion
= 7.1%

17. Why has it worked?
Adding a therapy resource to the existing medical and nursing ED team i.e. Dr can focus on medicine, nurse on nursing.
Therapists are used to crossing boundaries between hospital and community – connecting patients to services
Senior exec support – initially a novel team, took a risk!
Right people is critical
Invested in clinical specialists, extensive experience in COE and understand the system
Therapy leaders who develop a culture of embracing risk!
Work hard on relationships and connections
You need to invest
Making a real and sustained difference

18. What could have happened
Patient story
What happened
PC: ↑Confusion
Early Ax by OT,PT,SLT,Diet and MSW
Medically cleared
Discharge plan set
Outreach visit
Community supports
Referral to Geriatrician
Remained at home
What could have happened
Carer demands admission
Patient admitted
Becomes agitated (why am I here)
Sedated
↑ Confusion
No relatives at Ass. with DC
Unable to manage at home
Listed for LTC

19. Email details: paulmaloney@beaumont.ie
@FITTBeaumont