Bolton trust Discharge to Assess project frees acute NHS beds

A physiotherapist is helping to provide a successful Discharge to Assess (D2A) project which frees up acute hospital beds and gives people the opportunity to return home.


Members of the intermediate care at home team: administrator Shirley Morris, care supervisor Lisa Lomax, occupational therapist Sarah Lears, physio Rubina Adia and care supervisor Barbara Prescott

Rubina Adia, a specialist physio who works in an intermediate care at home team at Bolton NHS Trust. She is part of a multidisciplinary initiative introduced at Wilfred Geere House, a local respite care home for people with dementia.

Ms Adia and her occupational therapy colleagues, Lucy Parkin and Sarah Lears, have been developing a patient-focused therapy model at the care home since December 2016.

As part of the project, the care home has reserved seven of its beds for vulnerable patients who are admitted to the Royal Bolton Hospital with delirium or dementia.

Ms Adia said: ‘It’s been very successful in giving the patients the opportunity to be assessed to see if they can safely return to their own homes.

‘Rather than an alien hospital environment where patients might be moved from ward to ward, due to pressures for hospital beds, the D2A beds provide the perfect setting for our vulnerable dementia patients.

‘It is about assessing patients in the right place at the right time. With the help of the care home’s staff the project aims to allow patients and their families to be involved, at all stages, in any decisions about residents longer-term care needs.’

Assessments and discharge visits

Ms Adia and the occupational therapists assess each patients’ ability to transfer, mobilise and manage functional tasks. In addition, they liaise with their family and friends and identify any concerns that carers may have.

They also conduct a discharge visit for each patient. If people need more therapy, they will continue to provide this with the support of the intermediate care at home team.

‘We’ve had additional training regarding dementia and capacity assessments to develop good practice,’ said Ms Adia.

‘And because I’ve been involved with this project in addition to my main role, it’s proven beneficial for me to continue therapy input for patients that have been discharged home from Wilfred Geere, via my community physiotherapist role.’

She said the project demonstrated that different community services could work together with carers to support people with dementia to return home.

Additional staff involved in the scheme include a GP, a pharmacist, a social worker and an Age UK Coordinator.

Supporting out of hospital care

The project is based on NHS England’s D2A principle, which advocates supporting people to leave hospital when it is safe and appropriate, so their care can continue elsewhere and their longer-term needs can be assessed outside of a hospital environment.

Since the initiative started, it has received 68 vulnerable patients, freeing up the same number of acute beds at the Royal Bolton Hospital. Of these patients

  • 23 have returned home
  • 36 needed to go into 24-hour care
  • seven were re-admitted to hospital due to a deterioration in their health
  • one was admitted to an intermediate care bed
  • one died

Dementia Action Week

This year’s Dementia Action Week, the Alzheimer’s Society’s annual awareness raising campaign, starts on 21 May.

It is calling for people across the UK to take actions – large and small – that will make everyday life better for people affected by dementia.

Seeing the real person

Elaine Stock, a dementia lead physiotherapist at the Royal Surrey County Hospital, has written a poem to mark this year’s Dementia Action Week.

The poem, titled It’s me, highlights the importance of empowering people with dementia and encourages clinicians to see beyond a person’s diagnosis. A link to the full poem is available below.

Author: Robert Millett

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