2. Front door working in Combined Assessment NICOLA MEARNS Clinical Specialist Occupational Therapist October 2006

3. 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

4. First Assessment Trolley / Chair Nurse – Doctor (may include AHP) CommunityPlain X-ray Second Assessment Nurse / Doctor / Consultant Specialty Assessment Including AHP’s In-Patient Specialty Beds X- RAY CT US RIE CAA 2005

5. Staffing and Service provision Medical staff, including SPRs Nursing staff – enhanced roles Dedicated pharmacists Dedicated Primary Care Physician

6. 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)

7. The assessment of those with complex needs – the MDT Key words: team; multidisciplinary; 24 / 7

8. 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

9. Occupational Therapy - Pre admission status verification - ADL and Support Services Ax - Rapid access of equipment / care services The MDT in Combined Assessment

10. Physiotherapy - “Biomechanical” - Patterns of movement and coordination - Balance and gait - Exercise tolerance / walking aids

11. 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?

12. The MDT in CAA: Referrals, Risk and Outcomes Key words: assess; risk; communicate.

13. Therapy Referrals: Typical referrals - 1.Collapse / Falls 2.“Simple” medical illness 3.TIA / CVA 4.Complex needs / social /inadequate support 5.Alcohol abuse 6.Respiratory conditions

14. MDT Referrals: Patient Group Average age: 80 years old Average LoS: 48 hours

15. MDT Referrals: Reducing the Risk Risks Acute illness Age Complexity How Reduced? Assessment by relevant experts Communicate / work as a team

16. 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

17. Patient Assessment: Outcomes in CAA MDT Assessment / Intervention <24 hours / discharge 24 - 48 hours then home Rehabilitation

18. Reducing the Risk: Interfacing with Primary Care Patient Crisis care Old age psychiatry Social Work (Social Care Direct) Voluntary Services Community Nursing Services Hospital DRTs Mid/East/City General Practitioner Rapid response teams Domiciliary Physiotherapy Community Rehabilitation Teams Day Hospital MDT

19. 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

20. Summary Challenges 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

21. Thank you for listening Any Questions? nicola.mearns@luht.scot.nhs.uk

22. Complex needs process PHOTPCPPTNURPHOTPCPPTNUR LOS mean 48 hrs Range < 1-6 days GP/ A&E 53% Primary Care 46% admitted 60% on 40% off RIE CAA 2005

23. 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….

24. 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