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On #AHPsDay, the Programme Manager for the Transformation Team at Hampshire Hospitals NHS Foundation Trust explains how the Therapies team at the hospital’s ‘front door’ is helping reduce avoidable admissions:
I have always relished exploring new ideas – or taking things apart to see how they work – and during my NHS career I have enjoyed both delivering patient care and getting involved in research and service improvement.
Basingstoke and North Hampshire Hospital’s initiative ‘Early Doors: Can Emergency Care Therapies Help to Prevent Avoidable Admissions in the Emergency Department?’ came about following a 2016 visit from NHS Improvement’s Emergency Care Improvement Programme.
The reviewers recommended that Therapies move more senior decision makers to the ‘front door’ of the hospital where, for example, patients arrive for unplanned care such as in the Emergency Department, to support early discharge.
They also recommended that the hospital adopt a ‘discharge to assess’ model, where patients are discharged safely with support in place, and then receive a comprehensive assessment to plan their future care.
I was intrigued, and a colleague and I set about seeing what could happen if we thought about our assessments differently at the front door.
We checked the patient list for anyone likely to be admitted who we could perhaps get safely home instead. We found a patient who had no medical issues but whose wife and main carer was having difficulty at home. He was going to be admitted until social care was arranged.
The patient had dementia and Parkinson’s disease and by doing a risk assessment in place of our normal assessments – which would not likely reflect his real level of function as he wasn’t in his normal environment – we found that there was a real risk of deterioration in his health if he was kept in hospital. As a result, we immediately arranged rapid support for his wife to keep them both safely at home. We checked eight weeks later and saw that he still hadn’t come back in to hospital.
This showed that if we rethink our assessments, carry them out as early as possible, work alongside the multidisciplinary team and exploit our links with community services, we can directly help avoid unnecessary admissions.
Supported by a multi-disciplinary team of nurses, matrons, consultants, healthcare assistants and Emergency Department (ED) managers, we looked at ways the Therapies team could work differently.
We surveyed staff in the ED on their perceptions of our team and found that many didn’t know how or when to get hold of us or what we added to the patient journey. Because of these gaps in knowledge, Therapies input was in some cases being considered late in the day or not at all.
To address the issue of awareness, we ‘branded’ the team of occupational therapists, physiotherapists, and therapy practitioners as Therapies rather than focusing on our individual specialties. We produced posters, contact lists and team member profiles and attended team meetings to explain what we can achieve when we’re involved as early as possible in the patient journey.
By introducing this ‘one port of call’ and being really obvious about what we offer, we’ve managed to increase the number of patients assessed from up to five patients per week to 15 to 26 patients per week.
We found that the majority of therapy assessments in ED could be done by any member of the Therapies team, so we streamlined our assessments process and documentation.
We started to assess patients at ambulance handover, successfully supporting referral back home via the Home First pathway in under four hours. We also used patients’ NHS numbers from the ambulance inbound screen to access recent discharge summaries, meaning we could start assessment before a patient arrived at hospital.
Our work has increased early identification of patients who can be safely discharged, with discharges home from ED going from up to four per week to 10 to 12 per week.
We are seeing ever more Allied Health Professionals (AHPs) moving into non-traditional roles. In our Trust the quality improvement lead is an AHP and some AHPs are working in roles traditionally filled by doctors or nurses, such as matrons or even critical care outreach.
I have always mixed clinical work with research and service development wherever possible and have been very much supported to do so. As Physiotherapy Clinical Lead for Acute Care at Basingstoke and North Hampshire Hospital I encouraged everyone in the team to develop projects into abstracts and to share their successes on as wide a stage as possible – it doesn’t need to just be the big hospitals, or doctors and nurses who promote best practice.
AHPs offer such a wide skill set and they have truly embraced service improvement.
As a group we tend to be inquisitive and enthusiastic by nature. Let’s harness that energy as a rising force in the NHS.