Occupational Therapy News OTnews April 2019 | Page 36

FEATURE ACUTE CARE
Sophie Bennett and
Jean Fuller explain how the
frailty team at Hillingdon Hospital has
embedded within the emergency
department and is improving
patient flow
F
The ever growing
frailty team
railty is an important part of occupational
therapy practice and is becoming a ‘hot topic’
within the NHS.
People aged over 85 are 10 times more
likely to have an emergency admission and a longer
length of stay in an acute setting, and frail patients are
more likely to become deconditioned and susceptible
to hospital acquired infections the longer they stay in an
acute setting, which can impact on their independence
and quality of life at home.
Hillingdon Hospital’s 10-bed frailty unit was set up in
March 2017, and since then staff have completed the
NHS Acute Frailty Network ‘Cohort 5’ to help develop
the frailty service.
The frailty network supported the team to gather and
interpret data to show the impact a frailty team can have
on patient satisfaction and flow through the hospital. It
also supported staff to establish a frailty presence in the
emergency department and promote frailty around the
trust.
The team is comprised of six frailty specialists
-occupational therapists, physiotherapists and nurses -
two rotational band six therapists (occupational therapy
and physiotherapy), a rotational band five occupational
therapist, two therapy assistant practitioners and a
pathway co-ordinator.
The team covers the unit alongside rapid access
clinics, four frailty assessment areas and the emergency
department, which has designated frailty cubicles to
speed up frailty input.
Five dedicated consultant geriatricians and a nursing
team work alongside the therapists and have been
instrumental in the development and running of the frailty
service.
36 OTnews April 2019
Everyone aims to work in a holistic way, with a
person-centred approach; the team completes blended
assessments and has developed competencies to
ensure all staff are working to the same standard, to
provide the best care for patients.
Since expanding the frailty service, there has been a
substantial decrease in length of stay within the hospital
and discharges home from the emergency department
and the frailty assessment areas have increased.
Patients are screened using the Rockwood Frailty
Scale and a comprehensive geriatric assessment (CGA)
is completed for those scoring five or above.
Early intervention by therapists completing the CGA
has shown to reduce bed days occupied by patients
who are no longer requiring an acute inpatient stay, as
collateral history has been gathered and a discharge
plan is put in place for when they are medically fit for
discharge.
Having the frailty team has increased flow within
the hospital, as patients are able to be identified in the
emergency department and brought down to the frailty
assessment areas or frailty inpatient beds; this reduces
the amount of time frail patients are spending in the
emergency department and the acute hospital.
Initially, we struggled to make our presence known
in the emergency department; since then we have
developed frailty business cards, frailty screensavers on
the trust’s computers, and provided continuous training
to emergency department staff.
The team persisted in working in the emergency
department with patients with frailty and proactively
continued to bring patients from the emergency
department to the frailty unit and assessment areas.
All this hard work from the team has paid off, as it
is now an integral part of the emergency department
team and the first point of contact for patients with frailty
syndromes.
Following feedback from the emergency department
75 per cent of people strongly agreed that the frailty
team is beneficial to patient flow.
The team also works closely with community partners
to enable frail patients to stay out of the acute hospital;
30 per cent of patients in Hillingdon Hospital do not
need acute medical beds, therefore early intervention
and early supported discharges are essential.