Frail Elderly Assessment Unit (FEAU) Good Practice in Care of Learning Disability and the Vulnerable Adult Event 10th February 2012 Amanda M A Futers RN Ba(Hons) Nursing Amanda.futers@uhns.nhs.uk
Original Admission routes for FE patients From community to A&E A&E to MRA (AMU) MRA to SSU or MRA to EC ward or SSU to general Medical Ward then EC ward EC ward / Gen Med Ward to delayed discharge unit or back to community Up to 5 moves per patient per episode LOS increased average was 28-30 days Increase in vulnerability?!
Original FE Unit Elderly Assessment Ward 21B developed 11 beds for those patients attending A&E who fitted Bournemouth Criteria a set of complexities that categorise the patient as frail elderly (see slide 9) plus CGA DTA transferred to Male / female acute admissions Unit - proactive bed management by EC team. Advanced Nurse Practitioners' support 8-8pm with an interest in Elderly Care. Consultant ward round daily morning ward round. All patients categorised as requiring elderly care input in one place concentrating resource Ward 85 and 84 became step down rehabilitation ward female / male Dedicated and proactive Elderly Care nursing Staff NB Relied on AE to identify patients early and prevent transfer to non EC ward
Evaluation of Original model demonstrated: Positive outcomes Increased numbers of frail older people cared for in Elderly Care Unit (right patient right place) Fewer Older patients in other wards. Dedicated Elderly Care Unit with care delivered by appropriate staff with skills and competencies associated with speciality to complete CGA Negative Outcomes Poor identification in A&E therefore inconsistent access to services Inter ward Patient moves remained high increasing risk of infection, user dissatisfaction and LOS. Little effect on average Length of Stay which remained > 28 days (Gold Standard 12 days) No change in level of complaints or customer satisfaction No dedicated therapist cover No medical cover after 12midday and over weekends / BH
Moving forward to improve access to CGA teams Best practice solution (British Geriatric Society) early access to CGA and specialist MDT approach to management and care of FE patients Admission avoidance strategies to reduce unnecessary admission and focus on care delivery in community where safe to do so. Necessity to resource WTE Therapists, Medics, Community assessment teams, Specialist nurses to run a service over 12 hour day and weekend and BH. Ward staff to work proactively to pull the patient from emergency portals to improve quality of care and reduce AE waits which were distressing to most vulnerable. Hence Frail Elderly Assessment Unit (FEAU) - Dedicated Unit offering direct access to CGA direct from community and emergency portals.
What does it look like now? 18 available spaces made up of 14 Stryker trolleys + 4 beds Consultant geriatrician cover 9 8 weekdays and 9 3 weekends Senior Ward Nurses experienced in Care of the Elderly in charge 24hrs a day MDT approach from all services health / social care/ pharmacy Dedicated therapists Priority access for all investigations Clear admission criteria (Bournemouth Criteria) see slide 9 Dedicated Telephone Lines for referral Capacity for direct community admission avoiding AE all together.
How it works Referral received and patient screened against Bournemouth Criteria and acute presentation. No acute need - Patient case redirected to community services to provide rapid needs assessment and prevent admission to hospital for a social or mobility problem. Admission indicated user will attend FEAU from referral source for CGA Patient assessed within 4 hours of arrival and joint decisions made regarding acute hospital admission or step down to community where resources are available. Decision to admit (DTA) patient transferred to EC bed target stay on FEAU 24 hrs. max. Decision to discharge (DTD) referral to health and social care services to provide step down care in community and early follow up with Geriatrician clinics. FEAU does not admit on the basis of social need alone (exclusion criteria)
Bournemouth Criteria 90 years or above 65 years from a nursing or residential home or community hospital 75 years from home with 2 or more pre pre--existing conditions 1 Acute confusion 2 History of falls 3 Incontinence of urine and / or faeces 4 Reduced mobility 5 Dementia (AMT less than 7) 6 Care package breakdown 7 Multiple pathology
Results so far Positives The future Early CGA dedicated MDT Supported early discharge when indicated current LOS in EC wards now averages less than 12 days pre FEAU was 28+ days Reduced admission to AE for patients as Unit has direct admission policy Improved customer satisfaction and reduced complaints Only 1 acute hospital move from Assessment Unit to Ward. Reduced infection rates Early identification and follow up of Vulnerable adults WE are the first to deliver this model of care Higher percentage of direct community admission avoiding AE experience for the frailest patients On-going work with PCT s to support admission avoidance and deliver sub acute care at home Development of Frail Elderly out reach service NURSE LED! Continuous improvement of Care of the Elderly at UHNS Move to co-locate to new AE department providing less waiting in corridor and improving access to geriatric services Excellence in Practice Accreditation Scheme Award.
How do we reduce vulnerability to service users Early access to geriatrician services Right place, right time, right set of skills to deliver effective care Early identification of vulnerable adults and flag to safeguarding leads for social care and acute hospital Co-ordinated approach to discharge for VA users to ensure vulnerability reduced when discharged Expert safeguarding champion on Unit Learn by our own errors in regards to safeguarding and best practice. Users not left in ED s for long periods of time reducing risks of harm. Avoidance of ED with direct referral system
Thank you for listening