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Front door working in Combined Assessment

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

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Front door working in Combined Assessment

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  1. Front door working in Combined Assessment NICOLA MEARNS Clinical Specialist Occupational Therapist October 2006

  2. 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

  3. RIE CAA 2005 First Assessment Trolley / Chair Nurse – Doctor (may include AHP) Community Plain X-ray X-RAY CT US Second Assessment Nurse / Doctor / Consultant Specialty Assessment Including AHP’s In-Patient Specialty Beds

  4. Staffing and Service provision • Medical staff, including SPRs • Nursing staff – enhanced roles • Dedicated pharmacists • Dedicated Primary Care Physician

  5. 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)

  6. The assessment of those with complex needs – the MDT Key words: team; multidisciplinary; 24 / 7

  7. The MDT in the Combined Assessment • 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

  8. The MDT in Combined Assessment • Occupational Therapy - Pre admission status verification - ADL and Support Services Ax - Rapid access of equipment / care services

  9. The MDT in Combined Assessment • Physiotherapy - “Biomechanical” - Patterns of movement and coordination - Balance and gait - Exercise tolerance / walkingaids

  10. Why Therapy in Combined Assessment? • 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

  11. The MDT in CAA: Referrals, Risk and Outcomes Key words: assess; risk; communicate.

  12. Therapy Referrals: Typical referrals - • Collapse / Falls • “Simple” medical illness • TIA / CVA • Complex needs / social /inadequate support • Alcohol abuse • Respiratory conditions

  13. MDT Referrals:Patient Group Average age: • 80 years old Average LoS: • 48 hours

  14. MDT Referrals:Reducing the Risk • Risks • Acute illness • Age • Complexity • How Reduced? • Assessment by relevant experts • Communicate / work as a team

  15. 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

  16. Patient Assessment: Outcomes in CAA MDT Assessment / Intervention <24 hours / discharge 24 - 48 hours thenhome Rehabilitation

  17. Rapid response teams Day Hospital MDT Domiciliary Physiotherapy Community Rehabilitation Teams Reducing the Risk:Interfacing with Primary Care Crisis care Old age psychiatry Hospital DRTs Mid/East/City Patient Community Nursing Services General Practitioner Social Work (Social Care Direct) Voluntary Services

  18. 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

  19. 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

  20. Thank you for listeningAny Questions? nicola.mearns@luht.scot.nhs.uk

  21. Complex needs process PH PH OT OT PCP PCP PT PT NUR NUR LOS mean 48 hrs Range < 1-6 days 53% Primary Care GP/ A&E 46% admitted 60% on 40% off RIE CAA 2005

  22. Total Referrals: 52 patients Therapy Intervention in MAU:A Typical Week’s Activity…. 30 assessed fit for Home PT OT 32% Joint assessment 4% 64%

  23. Experience to Date TROLLEYS 25% trolley discharges 1100/m GP Toxicology 20% Monitors 20% CAA 600/m A/E 56% Direct Discharges 4% RIE CAA 2005

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