1. Day Hospitals What are they good for?
Dr K E Anderson
Royal Victoria Building
Western General Hospital
Edinburgh

2. Day Hospitals Born 1950’s – Model derived from psychiatry
Traditional model – Urban areas
Patients transported to and from
Assessment and rehabilitation
Several weeks attendance- emphasis on rehabilitation, respite and social care

3. Evolution 2012 More assessment - less rehabilitation
No remit for respite or social care
Competing with other services e.g. home rehab, ESD schemes, domiciliary physio, crisis care, rapid response, other intermediate care teams

4. Evidence
Cochrane Review RCT’S ( 2,500 subjects) DH versus ‘alternatives’ - 28% reduction in death or adverse outcome than those who received NO care.
Trend towards reduced bed usage and care placements in survivors

5. Evidence
Home versus day rehabilitation :RCT (small study) Crotty et al. Age and Ageing 2008;37:628-33
Home rehab just as good, less expensive, less treatment sessions.
2 x likely to be admitted to hospital with DH model

6. So - Day Hospitals Why do we have them? What are they for?
Do we really need them?

7. Day Hospitals in Lothian
OPRA (Leith CTC) - North East
ARC (Western General) - North West
Roodlands - East Lothian
Liberton - South Edinburgh
Templar - West Lothian

8. Who do we see? Patients requiring Comprehensive Geriatric Asst
Fall or minor injury, PD or Stroke with new functional decline
Chronic medical conditions and acute decline e.g. cardiac failure/COPD/Diabetes
Nutritional difficulties / weight loss
Continence issues
Cognitive decline
Family/carer anxiety about ability to cope

9. Who can refer? GP Hospital doctor/AHP/Nurse in any setting MOE wards
A/E dept, CAA/ARU/ Minor Injuries
Osteoporosis/PD Nurse specialists
Community therapists/social workers
Patients!

10. Why do we have them?
G.P's/patients like them and believe they are effective
Offer unique ‘One stop’ multidisciplinary assessment
Allow thinking time and breathing space for carers and GP (“R” word)
Allow elective (non urgent admission) in a time of crisis
( A good thing!)
Provide rehabilitation in a group setting
Specialist service - every body has appropriate training
Holistic approach with continuity of follow up

11. What is wrong with them? Perception of ‘capacity’ and ‘cost’
Waiting lists and large numbers of DNA’s
Lack of staffing and time
Lack of flexibility
Time consuming for patients
Transport issues
Lack of knowledge about referral pathways amongst potential users

12. What do we need to do better?
For GP’s – increase availability and rapid access
For patients- reduce travelling time/repeat visits and length of visit
For us- ensure all the processes are in place including IT support and evaluation of service

13. What are we doing? Continue doing what we do well e.g. CGA, falls
assessment and exercise programmes
Ensure awareness –talking to other services
Tackling DNA’s – telephone reminders
Streamlining services and processes across the sites e.g. access protocols, assessments, documentation
Sharing ideas e.g. aims, outcomes

14. What are we doing? Developing links with hospital teams e.g. COMPASS
Working towards integration with community teams and services e.g. provide a base for SPOC
Exploring the ‘virtual ward’ concept
Ensuring IT systems in the right place which talk to each other e.g. TRAK , E assess, Carenap
Collecting data

15. Agreed Outcomes for Managers
Admission avoidance
Rapid access to diagnostics
Community services support
Support early discharge from hospital

17. Challenges Ensuring a future Audit processes and outcomes
Making the case for expansion
Staffing the service all day and all week
Ensure the IT is up to it

18. Thank-You