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)

Community

Plain 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

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 / Falls2. “Simple” medical illness3. TIA / CVA4. Complex needs / social

/inadequate support5. Alcohol abuse6. 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 /

discharge24 - 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

CommunityNursingServices

Hospital DRTsMid/East/City

GeneralPractitioner

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

SummaryChallenges• 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 listeningAny Questions?

nicola.mearns@luht.scot.nhs.uk

Complex needs process

PH OT PCP PT NURPH OT PCP PT NUR

LOS mean 48 hrs

Range < 1-6 days

GP/ A&E 53% Primary Care

46% admitted 60% on 40%

offRIE 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