The Implementation of an advanced practitioner therapist Role within a community independence service.

Purpose

In Central Southampton, demand for Comprehensive Geriatric Assessment (CGA) was higher than capacity so GPs were sent requests such as medications review.

Audits showed that 60% of requests were not actioned, impacting on rehabilitation whilst waiting for a GP appointment.

This delay on patient care presented an opportunity to train a therapist to complete CGAs and enhance career development opportunities.

Patients receiving CGA had a mean length of hospital stay of 5.5 days if admitted,
7 days less than the comparison group (no CGA)
An average of 26 bed days
per month were saved.

Approach

A Quality Improvement (QI) project was set up for a trainee Advanced Practitioner Physiotherapist (APP) to complete CGAs within the Community Independence Service.

All falls referrals into the team were discussed with the Consultant Geriatrician who identified those requiring CGA at home. CGAs were completed by the Consultant Geriatrician and trainee APP between October 2017 and August 2018.

Data was collected on admission rate and length of hospital stay for 3 months following assessment, plus patient satisfaction and colleague experience on delayed rehabilitation.

Outcomes

329 patients were screened, with 61 identified as requiring CGA.

Capacity to accept patients from triage increased from 16% to 38%.

On follow-up, patients receiving CGA had a mean length of hospital stay of 5.5 days if admitted, 7 days less than the comparison group (no CGA).

An average of 26 bed days per month were saved.

The number of requests sent to GPs reduced by 62.5%, whilst staff confidence in the trainee APP completing CGAs increased from 10% to 90%.

100% of all CGA requests from both the consultant Geriatrician and trainee APP were actioned by GPs.

Colleagues reported 45% of their patients had rehab affected whilst waiting for a consultant or GP review prior to the QI, reducing to 7%.
 

Multi morbidity and falls are associated with frequent hospital admissions and a prolonged length of stay. Comprehensive Geriatric Assessment in the community provides a plan for patients and their GPs and significantly reduces length of hospital stay.

Implications

Investing in Allied Health Professionals to implement CGAs reduces the threshold and increases capacity, leading to considerable system wide cost savings, whilst enhancing recruitment and retention.

Funding acknowledgements

Quality Improvement project and pilot study in-house as part of job role. 

 

Additional notes

This work was presented at Physiotherapy UK 2019 and by poster presentation at the British Geriatric Society conference Cardiff 2019.