FEAT Project

Jane Youde on behalf of the FEAT Team

Where we were

• Specialty Take for Medicine

• Daily consultant ward rounds on MAU

• Support from ACPs for DME improved discharge rate to up to 25%, but no formal MDT working

• Some uncertainty about referral criteria to DME

System Assumptions

• Increased demand is only seen in the winter

• Frail older people are only cared for in DME

• There are limited evidence based interventions that improve outcomes for older people

Assumed In-Patient

Reality

CGA

• Comprehensive Geriatric Assessment (CGA) in a hospital setting reduces mortality by 25%, improves morbidity and increases the likehood of patients being at home 6 months later

• This requires a MDT which should include a geriatrician as well as a specialist nurse and rehabilitation specialist such as a physiotherapist and occupational therapist

CGA

Meeting the Challenge

• A group started in March 2013 with representatives from Acute and Community services to develop services for frail older people admitted to ED and MAU.

• Work to understand what the pathway was for frail older people and barriers to getting them out of hospital

• Defined “What good looks like for Acute Assessment of Frail Older People”

Solutions

• Developed and validated a 4 point screening tool

• If frailty is present a parallel assessment and care pathway is initiated along with the appropriate acute treatment

• No requirement for a senior medical opinion prior to assessment by the MDT

• Assume the patient will be discharged

Definition of Fraility

Screening Tool

• > 65 years old in a Care Home

• > 75 years old presenting with a fall

• > 75 years old presenting with confusion

• > 85 years old with 4 or more co-morbidities

• Assessed by a senior nurse, if meets this criteria flagged on iCM and then automatically seen by the FEAT team

Solutions

• Defined a pathway with shared

documentation

• The pathway includes onward referral to

community services and a personalised

agreed management plan

• Now have 7 day working

Current Community Referral Options

• ICS and SPAs (though no geriatrician input at present)

• Community Hospital with/out geriatrician input

• Rapid Assessment/Falls Clinic within 48 hours

• Community Support Workers

• Social Services

DAY

MON

TUES

WED

THURS

FRI

SAT

SUN

TOTAL

wc 03/02/14

DAY

MON

TUES

WED

THURS

FRI

SAT

SUN

TOTAL

MONTH TOTALS 189 79 60 76% 19

0

0

4

11 4

84 30 26 87%

4 100%

9 2 2 100%

7 1 1 100% 0

15 4 3 75% 1

14 8 7 88%

1

15 6 5 83% 1

13 5

1

TOTAL NUMBER

OF PATIENTS

SEEN BY THE FEAT

TEAM

NUMBER OF

PATIENTS

MEDICALLY FIT

FOR DC FROM RDH

NUMBER OF

PATIENTS

DISCHARGED

FROM RDH

% OF PATIENTS

DISCHARGED

FROM RDH

15

4 80%

NUMBER OF

PATIENTS

SUBSEQUENTLY

ADMITTED

05 1

105 49 34 69%

1 100%

13 9 9 100% 0

13 2 2 100%

14 8 4 50% 4

0

6

13 6 5 83% 1

24 13 7 54%

23 10 6 60% 4

TOTAL NUMBER

OF PATIENTS

SEEN BY THE FEAT

TEAM

NUMBER OF

PATIENTS

MEDICALLY FIT

FOR DC FROM RDH

NUMBER OF

PATIENTS

DISCHARGED

FROM RDH

% OF PATIENTS

DISCHARGED

FROM RDH

NUMBER OF

PATIENTS

SUBSEQUENTLY

ADMITTED

Current Data

• Increase in discharge rate at least comparable to beacon sites

• Long term data being collected but at present there is no indication that readmission rates have increased

Future of Feat

• Continue to embed FEAT on MAU and monitor long term outcomes

• Work with Acute Physicians on delivering ongoing input on the Short Stay Ward

• Develop this further in ED

• Develop robust pathways with community teams to ensure assessments and actions are completed

Future of Feat

• Develop a pre and peri-operative assessment service for surgery and T&O

• Deliver education regarding the care of frail older people to all levels of staff in the trust and community services

Response to Nicholson Comments on Frail Elderly

• The problem is not with our patients, the problem is with our health systems. Let's fix our health care system to make it responsive to the needs of the patients who require it. Let's change training and education to ensure that its staff possess the skills to manage people with multimorbidity, including older people. Let's enable prompt diagnosis and invest more in downstream systems designed to allow old people to leave hospital when ready to do so. Let's have equity of access for all patients who require it, and begin the overhaul of the NHS to make it fit for the 21st century.