Front door working in Combined Assessment NICOLA MEARNS Clinical Specialist Occupational Therapist October 2006
Philosophy of CAA GP and A&E referrals/admission 6 trolleys, 46 bedded unit Point of Entry diagnostics, assessment,treatment and reassessment Needs met by best-placed professional Information follows patient in real- time Specialist advice availability Estimated date of discharge
First Assessment Trolley / Chair Nurse – Doctor (may include AHP) CommunityPlain X-ray Second Assessment Nurse / Doctor / Consultant Specialty Assessment Including AHP’s In-Patient Specialty Beds X- RAY CT US RIE CAA 2005
Staffing and Service provision Medical staff, including SPRs Nursing staff – enhanced roles Dedicated pharmacists Dedicated Primary Care Physician
Staffing and Service provision cont. Dedicated Physiotherapy Dedicated Occupational Therapy Access to Dietetics and SALT 7 day (and PH cover)AHP Service (Safe Home service in A&E)
The assessment of those with complex needs – the MDT Key words: team; multidisciplinary; 24 / 7
Primary Care Physicians: - Split sessions between GP clinic / CAA - Complex needs / frail elderly patients - Develop patient-specific plans with MDT - Knowledge, communication and discharge facilitation The MDT in the Combined Assessment
Occupational Therapy - Pre admission status verification - ADL and Support Services Ax - Rapid access of equipment / care services The MDT in Combined Assessment
Physiotherapy - “Biomechanical” - Patterns of movement and coordination - Balance and gait - Exercise tolerance / walking aids
To obtain an accurate picture of an individual’s social, biomechanical and functional ability in the context of an acute illness presentation, and to facilitate appropriate decision making with regards direct discharge home or admission to speciality ward Why Therapy in Combined Assessment?
The MDT in CAA: Referrals, Risk and Outcomes Key words: assess; risk; communicate.
Therapy Referrals: Typical referrals - 1.Collapse / Falls 2.“Simple” medical illness 3.TIA / CVA 4.Complex needs / social /inadequate support 5.Alcohol abuse 6.Respiratory conditions
MDT Referrals: Patient Group Average age: 80 years old Average LoS: 48 hours
MDT Referrals: Reducing the Risk Risks Acute illness Age Complexity How Reduced? Assessment by relevant experts Communicate / work as a team
MDT Referrals: Reducing the Risk Unitary Patient Record: –Multiprofessional development –Sole document of patient’s care –Admission discharge timeline Real-time Case Conferencing –Unscheduled –Focussed
Patient Assessment: Outcomes in CAA MDT Assessment / Intervention <24 hours / discharge 24 - 48 hours then home Rehabilitation
Reducing the Risk: Interfacing with Primary Care Patient Crisis care Old age psychiatry Social Work (Social Care Direct) Voluntary Services Community Nursing Services Hospital DRTs Mid/East/City General Practitioner Rapid response teams Domiciliary Physiotherapy Community Rehabilitation Teams Day Hospital MDT
Summary Strengths Effective short-stay management Proactive empowered team working Specialist leadership Communication Dedicated pharmacy On site ADL assessment suite Safe discharge Crisis care and Emergency Duty SW at weekends/PHs
Summary Challenges Increasing elderly population in Edinburgh 4 hour target in A&E /Trolleys Equity of primary care services across East/Mid/city of Edinburgh 7 – day AHP cover across primary care services Access to Crisis Care in East Lothian Access to SWD at weekends/PHs
Thank you for listening Any Questions? firstname.lastname@example.org
Complex needs process PHOTPCPPTNURPHOTPCPPTNUR LOS mean 48 hrs Range < 1-6 days GP/ A&E 53% Primary Care 46% admitted 60% on 40% off RIE CAA 2005
32% 4% 30 assessed fit for Home Total Referrals: 52 patients 64% Joint assessment PT OT Therapy Intervention in MAU: A Typical Week’s Activity….
Experience to Date TROLLEYS CAA Toxicology 20% Monitors 20% 1100/m GP 25% trolley discharges 600/m A/E 56% Direct Discharges 4% RIE CAA 2005