FEAT Project - King's Fund Future of Feat ¢â‚¬¢Continue to embed FEAT on MAU and monitor long term outcomes

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  • 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.