Transcript Physiotherapy in a Medical Assessment Unit

Front door working in
Combined Assessment
NICOLA MEARNS
Clinical Specialist Occupational Therapist
October 2006
Philosophy of CAA
• GP and A&E referrals/admission
• 6 trolleys, 46 bedded unit
• Point of Entry diagnostics,
assessment,treatment and reassessment
• Needs met by best-placed professional
• Information follows patient in realtime
• Specialist advice availability
• Estimated date of discharge
RIE CAA 2005
First Assessment
Community
Trolley / Chair
Plain X-ray
Nurse – Doctor
(may include AHP)
Second Assessment
Nurse / Doctor / Consultant
Specialty Assessment
XRAY
CT
Including AHP’s
US
In-Patient Specialty Beds
Staffing and Service provision
• Medical staff, including SPRs
• Nursing staff – enhanced roles
• Dedicated pharmacists
• Dedicated Primary Care Physician
Staffing and Service provision
cont.
• Dedicated Physiotherapy
• Dedicated Occupational Therapy
• Access to Dietetics and SALT
• 7 day (and PH cover)AHP Service
• (Safe Home service in A&E)
The assessment of those with
complex needs – the MDT
Key words: team; multidisciplinary; 24 / 7
The MDT in the Combined
Assessment
• Primary Care Physicians:
- Split sessions between GP clinic / CAA
- Complex needs / frail elderly patients
- Develop patient-specific plans with
MDT
- Knowledge, communication and
discharge facilitation
The MDT in Combined
Assessment
• Occupational Therapy
- Pre admission status verification
- ADL and Support Services Ax
- Rapid access of equipment / care
services
The MDT in Combined
Assessment
• Physiotherapy
- “Biomechanical”
- Patterns of movement and
coordination
- Balance and gait
- Exercise tolerance / walking aids
Why Therapy in Combined
Assessment?
• To obtain an accurate picture of an
individual’s social, biomechanical and
functional ability in the context of an
acute illness presentation, and to facilitate
appropriate decision making with regards
direct discharge home or admission to
speciality ward
The MDT in CAA:
Referrals, Risk and Outcomes
Key words: assess; risk; communicate.
Therapy Referrals:
Typical referrals 1. Collapse / Falls
2. “Simple” medical illness
3. TIA / CVA
4. Complex needs / social /inadequate
support
5. Alcohol abuse
6. Respiratory conditions
MDT Referrals:
Patient Group
Average age:
• 80 years old
Average LoS:
• 48 hours
MDT Referrals:
Reducing the Risk
Risks
•Acute illness
•Age
•Complexity
How Reduced?
•Assessment by relevant experts
•Communicate / work as a team
MDT Referrals:
Reducing the Risk
• Unitary Patient Record:
– Multiprofessional development
– Sole document of patient’s care
– Admission  discharge timeline
• Real-time Case Conferencing
– Unscheduled
– Focussed
Patient Assessment: Outcomes
in CAA
MDT Assessment / Intervention
<24 hours /
discharge
24 - 48 hours
then home
Rehabilitation
Reducing the Risk:
Interfacing with Primary Care
Rapid response teams
Crisis care
Day Hospital MDT
Domiciliary
Physiotherapy
Hospital DRTs
Mid/East/City
Patient
Community
Rehabilitation
Teams
Social Work
(Social Care Direct)
Old age psychiatry
Voluntary
Services
Community
Nursing
Services
General
Practitioner
Summary
Strengths
• Effective short-stay management
• Proactive empowered team working
• Specialist leadership
• Communication
• Dedicated pharmacy
• On site ADL assessment suite
• Safe discharge
• Crisis care and Emergency Duty SW at weekends/PHs
Summary
Challenges
• Increasing elderly population in
Edinburgh
• 4 hour target in A&E /Trolleys
• Equity of primary care services across
East/Mid/city of Edinburgh
• 7 – day AHP cover across primary care
services
• Access to Crisis Care in East Lothian
• Access to SWD at weekends/PHs
Thank you for listening
Any Questions?
[email protected]
Complex needs process
PH
GP/ A&E
RIE CAA 2005
OT
PCP
LOS mean 48 hrs
Range < 1-6 days
46%
admitted
60% on
40% off
PT
PT
NUR
53% Primary
Care
Therapy Intervention in MAU:
A Typical Week’s Activity….
Total Referrals:
52 patients
30 assessed fit for Home
PT
32%
OT
Joint assessment
64%
4%
Experience to Date
TROLLEYS
1100/m GP
600/m A/E
Toxicology
CAA
20%
25% trolley discharges
Monitors
20%
56%
Direct
Discharges
RIE CAA 2005
4%