How (I try!) to avoid a hospital admission for someone with frailty

Dr Amy Heskett is a Speciality Doctor working in a Community Geriatrics team within West Kent called the Home Treatment Service. This team works alongside paramedics, GPs and district nurses to prevent unnecessary hospital admissions for people with frailty, multiple comorbidities, caring responsibilities or as part of end of life care.  The home visits use bedside testing and a multi-disciplinary approach to provide management of many acute medical presentations in a home-setting.  The development of these holistic plans requires a creative approach and the experiences often generate tweets @mrsapea and blogs at communitydoctoramy.wordpress.com

The bag I take on every home visit has numerous pockets with endless equipment and forms required at my fingertips. I clip the same badges and emergency kit to myself at the start of every shift and I take this order and strict routine with me into environments over which I have little control.  It is within this mix of structure and chaos that the creativity to manage conditions and sometimes crises within a community setting arises.

Publications and conferences have explained the importance of avoiding unnecessary hospital admissions (especially for those with frailty) and commissioners require data on the number we have achieved. Continue reading

Paramedics; Frailty detection and admission avoidance

Dr Amy Heskett works as a Speciality Doctor within the West Kent Urgent Care Home Treatment Service. This team aims to prevent hospital admissions by working alongside GPs, nurses, carers and paramedics to provide a holistic management plan. She writes a blog about her experiences on her blog communitydoctoramy.wordpress.com and can be found on twitter @mrsapea

paramedics-photoThe West Kent Home Treatment Service provides home-based medical treatments to avoid hospital admissions when appropriate. Referrals come from GPs, Community Nurses and Paramedics; but more importantly our team widens as soon as we start to work with patients, their family and carers.

A day of referrals began with a call from a Paramedic who had attended V after she had fallen in her bedroom, but luckily sustained no injury. This was on a background of dementia and the need for daily support from her son to assist with meals, prompt medications and support trips made outside the home. V’s only other medical history was that of hypertension and one fall a year ago. V was normally able to get herself to the toilet and used a stick to mobilise slowly indoors; while carers attended once a day to provide personal care. Continue reading

Reducing hospital admissions: a new integrated model for care homes

Sally Roberts is Lead Nurse (Quality and Partnerships) at Walsall Clinical Commissioning Group. Here she describes work undertaken jointly by Walsall CCG and Walsall Healthcare NHS Trust, which has led to the implementation of a new integrated health care model within care homes.

Walsall’s new model of care has enabled the whole care home sector to raise standards, measurably improve outcomes for residents in care homes and reduce unnecessary hospital admissions.

Our work commenced in earnest with the nursing home sector over three years ago, at a time when there was increasing suspension of admissions, often due to poor quality and patient safety issues; these reduced market capacity and choice for people, and created financial uncertainty for some smaller independent homes. Care home managers reported in several forum meetings that they were struggling with poor staff retention, disrupting stability of care, leading to ineffective planning and viability of the home in the long term. In addition, the lack of proactive management of patients resulted in a high number of avoidable hospital admissions.

Continue reading

Frailsafe – “All share, all learn”

logoZoe Wyrko is the BGS Director of Workforce Planning; she’s previously blogged about Frailsafe, the British Geriatrics Society project funded by the Health Foundation to improve the acute care of older people being admitted to hospital, and tweets @geri_baby.

Frailsafe is starting to happen! It’s been an exciting (and exhausting) week for the team, with the first learning session taking place over three days in Sheffield.

In addition to multidisciplinary teams from the 12 sites chosen to take the project forward, we have had stakeholder involvement with Tom Gentry from AgeUK, patient involvement with Olive and Ron who attended a couple of sessions on day 2, but more importantly an overwhelming sense of enthusiasm to make the Frailsafe checklist for admissions work. We’ve been immortalised in art by our illustrator, and we’ve been interviewed and filmed for a Frailsafe promotional video.

The learning environment has been truly multidisciplinary, (doctors, nurses, physiotherapists, OTs, pharmacists and hospital managers) and the team from Sheffield Microsystems Coaching Academy have been sharing their extensive skills and knowledge with us. Some of the concepts have been totally new, but in other areas I’ve been left thinking ‘Why on earth haven’t we been doing that already? It seems so logical.’ And I’m not the only one: another colleague is relieved because he now understands why his managers keep trying to make him do things with Post-it notes.

BydHrrGIAAATddsAn element of cynicism is likely when doctors are presented with timetables which include a ‘paper aeroplane factory’ and ‘the marshmallow challenge,’ but with hindsight it is impossible to argue with the practical illustrations delivered by these training sessions. Why are we as clinicians so reluctant to adopt proven messages and systems learned by industry to improve quality and consistency? Even the ice-breaker – asking delegates to arrange themselves in a line according to distance travelled – was a lesson in systems and complexity. We have learnt about the psychology of improvement, how to understand and appreciate systems, and how even at a relatively basic level of knowledge we can improve the patient journey while bringing colleagues along with us.

We’ve also been able to speak about how Frailsafe got to where it is now; the reasoning behind the questions we chose for the checklist, and (probably more importantly) why certain areas are not included. The unveiling of Frailsafe version 8 was a big moment, and emphasised  the importance of having professional designers involved in a project such as this!

Byc4dqlIgAAZ7suThe final day of the session was used for planning, with  each hospital team working with the microsystems coach who will be supporting them closely throughout the Frailsafe project. The sites each left with an individual plan of how they will start to use the checklist immediately, using the mantra of ‘start small, get bigger,’ but, more importantly, reassurance and understanding of what to do if success isn’t immediate.

Our continued thanks go to the Frailsafe partners, especially The Health Foundation who have made this work possible. Please look at our website, as many of the learning materials will be available there soon.

And if anyone is interested – Glasgow and Craigavon jointly won the paper aeroplane factory, and Sandwell were the ‘Mr Potato Head’ champions!