Clinical assessment service

Our service is seen as really helpful by the emergency department (ED) and medical teams. There has been a reduction in emergency admission of older people especially those who were referred from our local therapist assessment in ED, requiring further support. When a geriatrician assesses them, I can take the risk and get them home with support, as I know what is available in the community. The patients get better continuity of care, they see the same clinician in ED whom they then see in the community and that really helps their confidence in the team. The rotation of staff from acute care to the community means we understand much better what provision we can all give. I can now understand far better what can be provided within the community and the people from the community can now the pressures on the acute sector, so we work much better together.

Mainly our service takes referrals from ED, although the community teams will now phoneme and say, ‘I’m not sure about this patient’, so I will suggest, ‘Well bring them in and we can assess them’. The team will also go to the 11ampost-take general medicine multidisciplinary team meeting for everyone admitted in the previous 24 hours and identify patients whom we think we can transfer back home or support in the community. I hope this promotes the service and shares learning. Direct GP referral is a big element that is missing and that’s our next step.

It’s a win–win situation for both the commissioners and us because it keeps people out of hospital and it’s cheaper than a hospital bed. When I talk to patients most of them have said they are glad they didn’t come into hospital. Having good relationships with the community teams, with the community matrons and the early supported discharge teams make it work.

For example, there was somebody I saw on the Bank Holiday weekend. It was all very non-specific so initially the thought from ED was ‘send her home’. However, talking to her and to her family it was clear that she wasn’t coping as well at home; she wasn’t doing as much as she could and there had been are cent decline in function. We saw her and she had a marked postural drop so I reviewed her antihypertensive medication and because we didn’t have a community bed at the time she went to one of our intermediate care beds. I saw her again yesterday – her mobility has improved, she is doing better and she will be going home with ongoing rehab in the community.

Lewisham University Hospital

Hospital size: 450 beds. Acute take 25–40

patients/24 hours.

Challenge faced: Increasing older patients presenting to ED, with potentially prolonged stays exacerbated by hospitalisation.

Solution: Clinical assessment service based in ED. Front-door geriatric assessment for ED and community referrals (planning to expand to GP). Multidisciplinary team with occupational therapist, physiotherapist, social worker, nurses who rotate through front door and community services. Provide access to 72-hour community tariff beds, step-up beds and short-term enhanced home care. Supervised by same team.

Local context: Trust is combined acute and community trust.

Staffing: 2 whole-time equivalent (WTE) occupational therapists, 2 WTE physiotherapists, 1.5 band 6 nurse, 0.3 WTE consultant geriatrician, 2 WTE social assessors.

Outcome: For May–Sept 2012, an average reduction in hospital admissions of 30 patients per month.