NHS Board Contact . NHS Forth Valley Jann Gardner Title Category Background/ context

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1 NHS Board Contact NHS Forth Valley Jann Gardner Title Category Background/ context Problem Development of a Rapid Access Frailty Service Older People With an ageing population the hospital inpatient service was seeing more and more patients who are frail with complex needs. Although in Forth Valley we have a lower rate of hospital admissions for over 65 years, we also know that there is variation in patient length of stay for a variety of reasons including demand into and flow out of the hospital system. It is well documented that extended lengths of stay can have a significantly detrimental effect on long term care needs and patient outcomes. Having undertaken a review of frail elderly inpatients we believed that there was scope to develop a service to address some patients needs in an ambulatory setting reducing the need for an unnecessary hospital admission. This project sits at the heart of inpatient capacity and flow, health and social care integration and community services and is part of the whole system working required to provide better outcomes for older people through collaborative working to achieve shared goals. Frail elderly patients frequently have period of decline where specialist review and intervention is required. During these periods they are often admitted to hospital either following a fall or for review. Diagnostics and treatment plans can take some time and during this time, in the hospital setting, they may lose further mobility and reduced nutritional intake and are exposed to the risk of hospital associated infections (HAIs). Built on the back of work undertaken by Dr Tom Downes in Sheffield we developed a proposal to test the provision of the required assessment and treatment within a specialist, multidisciplinary ambulatory setting.

2 Aim Action taken Results The aim of this project is to improve outcomes for frail elderly patients by reducing avoidable hospitalisation and supporting patients to be cared for in their own home/communities with the following key objectives: provision of timely comprehensive geriatric assessment allowing streamlining of patients to an inpatient or ambulatory pathway reduce avoidable admissions through rapid access clinic assessment and treatment timely discharge from inpatient pathway as soon as possible when acute care no longer adds value reduce avoidable disability/harm with potential associated on-going burden of care and loss of independence optimise partnership approach between the NHS, patients, carers, primary care, social care, community service, mental health, other specialties improve patient and carer experience Outcome Measures improved timey access by primary care team to specialist review reduce avoidable admissions (min of 50 per cent) from rapid access frailty ambulatory care improved patient and carer experience greater involvement of carers in assessment and pathway reduced wait for specialist assessment with associated improvement in quality of care rapid access to one stop diagnostics improved communication and planning with social work service reduce length of stay in inpatient ward rapid access to allied healthcare professional assessment

3 and community rehab services Patient experience Staff experience Efficiency savings and productive gains The benefits for patients and carers are numerous: patients can be seen as a day patient allowing them to return home at night patients are encouraged to come with a family member or carer which gives them support and often means the patient feels more relaxed and the better information can be shared with the team access is timely and review will be carried out with a plan before the patient leaves where follow up is required there is continuity of care as the patient is brought back to the clinic area feedback has been extremely positive and patients and families have embraced the concept The staff involved in the service find it very rewarding as the patient is seen quickly, has an excellent quality of review by a multidisciplinary team and leaves with a holistic package to meet their medical, physical and social needs. Again staff feedback from the service and from NHS staff referring to the service has been very good. The primary benefit for the patient is that their treatment plan and additional support are put in place in a very timely manner. This improved the quality of care and improves the outcomes for that patient. The associated benefits of this are numerous including admission avoidance, potential complications related to a protracted hospital stay and onward support packages or care needs required. On a basic level the service is seeing approximately 40 patients per month with admission avoidance at 87 per cent (average) as seen below.

4 This benefit can be considered in two ways either as a reduction in bed costs or added resilience to enable flow within the acute setting with increasing demand. We assessed that all patients who avoided admission would have otherwise required admission. If we assume that 50 per cent of patients would have had a length of stay of and 50 per cent at 14 days this equates to a bed saving of approximately 14 beds per day. However, our overall admission levels have remained relatively static which suggests that this saving is in effect offsetting the expected demand due to demographic changes as predicted from ISD prediction information below: Sustainability Lessons learned Change Fund monies have been used to aid redesign of service however it is planned to bring this into core funding. It is also planned to develop this from a five day to a seven day a week service. Good approach taken with key outcome measures. Used weekly Oobeya - Big Room approach which helped to land team ownership and involved a wide number of stakeholders in the development. Challenges not to underestimate the need for

5 communication across a whole system.