6 7 Meet the teams with winter firmly in their sights Our emergency departments are facing pressure like never before. In this issue of Freepress we take a look at some of the innovative ways staff are tackling waiting times to ensure patients are seen by the right person at the right time in the right place. ‘One-stop shop’ frailty review BH treats one of the largest elderly populations in London. Now frail patients coming to BH via the emergency department (ED), or even referred by their GP, are being supported by a team determined to help them via a ‘one-stop shop’ approach. At the front door, patients are identified by ED staff and then sent for assessment by a team of frailty specialists, including consultant geriatricians, resident doctors working in elderly care, nurses and rapid emergency acute care treatment (REACT) therapists. Anyone aged 65 and over with a frailty score of 5 and above is referred to the frailty team for treatment. Emma Lewis, a consultant therapist for frailty, said: “The idea is this is a one-stop shop review of everything that’s important to this person at this point in time. Often there can be a lack of co-ordination and joined up care when it comes to elderly patients, but we bring it all together in lots of detail and make an action plan to get people to be as well as they can be, for as long as they can be, and to live with as good a quality of life as possible.” Claire King, consultant geriatrician, added: “We’re also trying to identify the acute cause of what the patient has come in with. The overall aim is to be able to support frail older patients to feel better after this multi-faceted intervention and assessment, so they are hopefully able to go back home or to their place of residence the same day. We can offer ongoing support from our Hospital at Home or community services. That link with the community is crucial.” Currently 65% of these patients are able to go home the same day. Of those, 20% are referred on to other admission avoidance services such as Hospital at Home. L-R: Kalpana Pandhare, ED staff nurse and Karen Archer, senior manager for North Mid ED Brooke Reeve and RFH ED matrons Members of the frailty team at BH Better flow A new digital front door will be coming to RFH shortly so walk-in patients can book themselves in. Depending on what they type in, they will be sent to ED, same day emergency care (SDEC) or see an on-site GP. Brooke Reeve, an operations manager at the RFH, said the digital service had been well received already at other trusts and shown to support better care coordination. In addition, on-site GP hours have been extended from 12.5 hours to 15 hours which is helping more patients get better access to the right level of care for them. Brooke said: “Going into winter reducing ambulance handover times, improving real time ED performance reporting and working with our system partners to reduce unnecessary admissions are just some of the other ways we will manage demand.” Pharmacy First New at North Mid this winter is Pharmacy First, a pilot scheme aimed at improving ED waiting times, reducing pressure on staff and getting patients the care they need in the right place. Patients who attend with minor ailments such as earache, sore throats, or urinary tract infections, are assessed by a ‘hello’ clinician and advised if a pharmacist would be able to provide advice. If the patient is happy to be referred, a digital referral is sent to a pharmacy local to the hospital, or local to them, using the Pharma Refer system. The system records the patient’s outcome from their visit, just in case they need to return to ED, and they can rejoin their original place in the queue. That link with the community is crucial “ “ Since the service started 18 months ago, unplanned readmission rate 30 days after review now stands at just 14%, which is the same as any other person over 65. This is a remarkable achievement, especially given the average age of the patients seen by the frailty team is 86. For patients who can’t go home, the in-depth assessment right at the start clearly pays off as they continue on their hospital journey. Their length of stay has been shown to be shorter than the average patient on an elderly care ward. The team are passionate about their work and see up to 100 patients each month. Claire said: “Having the time to really delve into quite a lot of complexity and do something about it is so rewarding and we get to do all this within a space of a few hours.” Currently there are four chairs available for patients who can sit but patients will also be seen in bed if necessary. In future the team would like to see a dedicated assessment space where they can see up to 12 patients over a longer timeframe and investment to grow the workforce and its nursing expertise. Emma said: “At the moment we see the oldest and the sickest patients but we could do so much more. We have an ageing population and Barnet has the most care homes of any borough in the country. There’s a huge amount of need.” Staff at the opening of the new emergency ambulatory care unit at North Mid On the first day the pilot launched eight referrals were made and the target is to refer between five and 10 patients a day. Training is continuing to take place so staff feel comfortable reassuring patients. Karen Archer, service manager for North Mid ED, said: “Going into winter we see a lot of patients with sore throats. Many of these patients can now be referred directly to their local pharmacy – it’s quicker for them and can help improve waiting times for patients needing emergency care.” Making an impact Another innovation at North Mid is the emergency ambulatory care unit (EACU). Running since May the unit has created additional capacity, adjacent to ED, to provide treatment for patients whose conditions are stable and non-complex, and which don’t require admission but are likely to take more than four hours due to ongoing treatment, observation and reviews. The calm space has 10 treatment chairs and 20 waiting room chairs, and is seeing approximately 80 patients on weekdays and 50 at weekends. Nick Vincent, general manager for ED, hot floor and care of the elderly, said: “These are patients who might need fluids or we are waiting on imaging reports or further investigations, so we know it’s going to take a bit longer to care for them. Patients have been very positive about the unit and staff love working here. We can already see it has made an appreciable difference by helping reduce the crowding in the main ED waiting room. “The unit is going from strength to strength, and we are aiming to provide a full 24-hour service in the coming weeks as we recruit more doctors using NHS urgent and emergency care improvement funding.”
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