Front Door admission avoidance

Purpose

The 6 Essential Actions of Improving Unscheduled Care in Scotland focuses on developing the relationships between Health and Social Care Partnerships, by reducing hospital admissions and to ensure a timely discharge of patients from hospital. In order to achieve this, the Front Door team, a team of Physiotherapists (PT) and Occupational Therapists (OT) at Glasgow Royal Infirmary commenced working in the Emergency Department (ED). This is in addition to the service within the Acute Assessment Unit (AAU). It was recognised that a large proportion of patients admitted to hospital from ED or AAU were from the older peoples patient group. One of the main reasons for this was because there was no therapy team in ED/AAU to assess patients and prevent admission of patients who did not require acute hospital care. This team provides comprehensive, generic assessments, meaning patients can be assessed by the one therapist, therefore reducing duplication and aiming to work within the 4 hour target time. The team’s overall focus is to prevent hospital admissions and improve access to community services.

80 patients
were discharged after therapy intervention in the emergency department in the first 12 weeks

Approach

The service runs Monday – Friday 0800 – 1700. Patients are identified for early therapy intervention by attending daily AM and PM huddles in ED and AAU, monitoring patients on Trakcare throughout the day and referrals received from medical and nursing staff. An in depth social history is recorded and the following are used to collate information: Clinical portal, Emis, social work and Home Care apps. An objective assessment is completed in order to clinically reason if the patient is fit for discharge. A Multi Disciplinary Team decision is made on whether the patient is medically fit and safe for discharge with or without community rehabilitation, homecare, social work or third sector support. In order to measure how effective the service is, the following outcomes are recorded for each patient:

· Number of patients with therapy facilitated discharges in ED

· Number of patients with therapy facilitated discharges in AAU

· Number of patients that would have been admitted if there was no therapy service in place.

Outcomes

Results: Since the service commenced 12 weeks ago. The following results have been collected. 80 patients were discharged after therapy intervention in ED 42 patients were discharged after therapy intervention in AAU 67 patients across ED and AAU would have been admitted if there was no therapy service available. Qualitative feedback from medical and nursing staff in ED/AAU was received regarding the service. The main consensus from the feedback indicated that staff felt the service was an excellent addition to ED/AAU and they would like to see the working hours extended.

Conclusion(s): Therefore, the results suggest that the team have had a positive impact within ED and AAU assisting in preventing hospital admissions.

Cost and savings

No further information. 

Implications

We are reviewing our current working hours within the service, in order to provide extended hours enabling us to assist in preventing admissions. We are also looking at the possibility of creating a 7 day service to support admission avoidance.

Top three learning points

No further information. 

Funding acknowledgements

No funding acknowledgements.