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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
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
