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Frail Elderly AssessmentUnit
(FEAU)
Good Practice in Care of Learning Disabilityand the Vulnerable Adult Event
10th February 2012
Amanda M A Futers RN Ba(Hons) [email protected]
From community to A&E A&E to MRA (AMU) MRA to SSU or MRA to EC ward or SSU to general Medical Ward then EC
ward EC ward / Gen Med Ward to delayed
discharge unit or back to community
Up to 5 moves per patient per episode LOS increased average was 28-30 days Increase in vulnerability?!
Original Admissionroutes for FE patients
From community to A&E A&E to MRA (AMU) MRA to SSU or MRA to EC ward or SSU to general Medical Ward then EC
ward EC ward / Gen Med Ward to delayed
discharge unit or back to community
Up to 5 moves per patient per episode LOS increased average was 28-30 days Increase in vulnerability?!
Elderly Assessment Ward 21B developed 11 beds for those patients attending A&E who
fitted Bournemouth Criteria – a set ofcomplexities that categorise the patient as frailelderly (see slide 9) plus CGA
DTA transferred to Male / female acuteadmissions Unit - proactive bed management byEC team.
Advanced Nurse Practitioners' support 8-8pmwith an interest in Elderly Care.
Consultant ward round daily morning wardround.
All patients categorised as requiring elderly careinput in one place concentrating resource
Ward 85 and 84 became step down rehabilitationward female / male
Dedicated and proactive Elderly Care nursingStaff
NB Relied on AE to identify patients early andprevent transfer to non EC ward
Original FE Unit
Elderly Assessment Ward 21B developed 11 beds for those patients attending A&E who
fitted Bournemouth Criteria – a set ofcomplexities that categorise the patient as frailelderly (see slide 9) plus CGA
DTA transferred to Male / female acuteadmissions Unit - proactive bed management byEC team.
Advanced Nurse Practitioners' support 8-8pmwith an interest in Elderly Care.
Consultant ward round daily morning wardround.
All patients categorised as requiring elderly careinput in one place concentrating resource
Ward 85 and 84 became step down rehabilitationward female / male
Dedicated and proactive Elderly Care nursingStaff
NB Relied on AE to identify patients early andprevent transfer to non EC ward
Evaluation of Original modeldemonstrated:
Positive outcomes Increased numbers of
frail older people caredfor in Elderly Care Unit(right patient rightplace)
Fewer Older patients inother wards.
Dedicated Elderly CareUnit with care deliveredby appropriate staffwith skills andcompetenciesassociated withspeciality to completeCGA
Negative Outcomes Poor identification in
A&E thereforeinconsistent access toservices
Inter ward Patientmoves remained highincreasing risk ofinfection, userdissatisfaction and LOS.
Little effect on averageLength of Stay whichremained > 28 days(Gold Standard 12 days)
No change in level ofcomplaints or customersatisfaction
No dedicated therapistcover
No medical cover after12midday and overweekends / BH
Positive outcomes Increased numbers of
frail older people caredfor in Elderly Care Unit(right patient rightplace)
Fewer Older patients inother wards.
Dedicated Elderly CareUnit with care deliveredby appropriate staffwith skills andcompetenciesassociated withspeciality to completeCGA
Negative Outcomes Poor identification in
A&E thereforeinconsistent access toservices
Inter ward Patientmoves remained highincreasing risk ofinfection, userdissatisfaction and LOS.
Little effect on averageLength of Stay whichremained > 28 days(Gold Standard 12 days)
No change in level ofcomplaints or customersatisfaction
No dedicated therapistcover
No medical cover after12midday and overweekends / BH
Best practice solution (British GeriatricSociety) early access to CGA and specialistMDT approach to management and care ofFE patients
Admission avoidance strategies to reduceunnecessary admission and focus on caredelivery in community where safe to do so.
Necessity to resource WTE Therapists,Medics, Community assessment teams,Specialist nurses to run a service over 12 hourday and weekend and BH.
Ward staff to work proactively to ‘pull’ thepatient from emergency portals to improvequality of care and reduce AE waits whichwere distressing to most vulnerable.
Hence – Frail Elderly Assessment Unit(FEAU) - Dedicated Unit – offering directaccess to CGA direct from community andemergency portals.
Moving forward to improveaccess to CGA teams
Best practice solution (British GeriatricSociety) early access to CGA and specialistMDT approach to management and care ofFE patients
Admission avoidance strategies to reduceunnecessary admission and focus on caredelivery in community where safe to do so.
Necessity to resource WTE Therapists,Medics, Community assessment teams,Specialist nurses to run a service over 12 hourday and weekend and BH.
Ward staff to work proactively to ‘pull’ thepatient from emergency portals to improvequality of care and reduce AE waits whichwere distressing to most vulnerable.
Hence – Frail Elderly Assessment Unit(FEAU) - Dedicated Unit – offering directaccess to CGA direct from community andemergency portals.
18 available spaces made up of 14 Strykertrolleys + 4 beds
Consultant geriatrician cover 9 – 8weekdays and 9 – 3 weekends
Senior Ward Nurses experienced in Careof the Elderly in charge 24hrs a day
MDT approach from all services health /social care/ pharmacy
Dedicated therapists Priority access for all investigations Clear admission criteria (Bournemouth
Criteria) – see slide 9 Dedicated Telephone Lines for referral Capacity for direct community admission
avoiding AE all together.
What does it look like now ?
18 available spaces made up of 14 Strykertrolleys + 4 beds
Consultant geriatrician cover 9 – 8weekdays and 9 – 3 weekends
Senior Ward Nurses experienced in Careof the Elderly in charge 24hrs a day
MDT approach from all services health /social care/ pharmacy
Dedicated therapists Priority access for all investigations Clear admission criteria (Bournemouth
Criteria) – see slide 9 Dedicated Telephone Lines for referral Capacity for direct community admission
avoiding AE all together.
Referral received and patient screened againstBournemouth Criteria and acute presentation.
No acute need - Patient case redirected tocommunity services to provide rapid needsassessment and prevent admission to hospital for asocial or mobility problem.
Admission indicated – user will attend FEAU fromreferral source for CGA
Patient assessed within 4 hours of arrival and jointdecisions made regarding acute hospital admission orstep down to community where resources areavailable.
Decision to admit (DTA) patient transferred to ECbed– target stay on FEAU 24 hrs. max.
Decision to discharge (DTD) referral to health andsocial care services to provide step down care incommunity and early follow up with Geriatricianclinics.
FEAU does not admit on the basis of social needalone (exclusion criteria)
How it works
Referral received and patient screened againstBournemouth Criteria and acute presentation.
No acute need - Patient case redirected tocommunity services to provide rapid needsassessment and prevent admission to hospital for asocial or mobility problem.
Admission indicated – user will attend FEAU fromreferral source for CGA
Patient assessed within 4 hours of arrival and jointdecisions made regarding acute hospital admission orstep down to community where resources areavailable.
Decision to admit (DTA) patient transferred to ECbed– target stay on FEAU 24 hrs. max.
Decision to discharge (DTD) referral to health andsocial care services to provide step down care incommunity and early follow up with Geriatricianclinics.
FEAU does not admit on the basis of social needalone (exclusion criteria)
90 years or above90 years or above 65 years from a nursing or65 years from a nursing or
residential home or communityresidential home or communityhospitalhospital
75 years from home with 2 or75 years from home with 2 ormoremore prepre--existing conditionsexisting conditions
1 Acute confusion2 History of falls3 Incontinence of urine and / or
faeces4 Reduced mobility5 Dementia (AMT less than 7)6 Care package breakdown7 Multiple pathology
Bournemouth CriteriaBournemouth Criteria
90 years or above90 years or above 65 years from a nursing or65 years from a nursing or
residential home or communityresidential home or communityhospitalhospital
75 years from home with 2 or75 years from home with 2 ormoremore prepre--existing conditionsexisting conditions
1 Acute confusion2 History of falls3 Incontinence of urine and / or
faeces4 Reduced mobility5 Dementia (AMT less than 7)6 Care package breakdown7 Multiple pathology
Results so far Positives Early CGA dedicated MDT Supported early discharge
when indicated – currentLOS in EC wards nowaverages less than 12 days –pre FEAU was 28+ days
Reduced admission to AEfor patients as Unit hasdirect admission policy
Improved customersatisfaction and reducedcomplaints
Only 1 acute hospital movefrom Assessment Unit toWard.
Reduced infection rates Early identification and
follow up of Vulnerableadults
WE are the first to deliverthis model of care
The future Higher percentage of direct
community admissionavoiding AE experience forthe frailest patients
On-going work with PCT’sto support admissionavoidance and deliver subacute care at home
Development of FrailElderly out reach service -NURSE LED!
Continuous improvementof Care of the Elderly atUHNS
Move to co-locate to newAE department providingless waiting in corridor andimproving access togeriatric services
Excellence in PracticeAccreditation SchemeAward.
Positives Early CGA dedicated MDT Supported early discharge
when indicated – currentLOS in EC wards nowaverages less than 12 days –pre FEAU was 28+ days
Reduced admission to AEfor patients as Unit hasdirect admission policy
Improved customersatisfaction and reducedcomplaints
Only 1 acute hospital movefrom Assessment Unit toWard.
Reduced infection rates Early identification and
follow up of Vulnerableadults
WE are the first to deliverthis model of care
The future Higher percentage of direct
community admissionavoiding AE experience forthe frailest patients
On-going work with PCT’sto support admissionavoidance and deliver subacute care at home
Development of FrailElderly out reach service -NURSE LED!
Continuous improvementof Care of the Elderly atUHNS
Move to co-locate to newAE department providingless waiting in corridor andimproving access togeriatric services
Excellence in PracticeAccreditation SchemeAward.
How do we reducevulnerability to service
users Early access to
geriatrician services Right place, right
time, right set of skillsto deliver effectivecare
Early identification ofvulnerable adults andflag to safeguardingleads for social careand acute hospital
Co-ordinatedapproach to dischargefor VA users to ensurevulnerability reducedwhen discharged
Expert safeguardingchampion on Unit
Learn by our ownerrors in regards tosafeguarding and bestpractice.
Users not left in ED’sfor long periods oftime reducing risks ofharm.
Avoidance of ED withdirect referral system
Early access togeriatrician services
Right place, righttime, right set of skillsto deliver effectivecare
Early identification ofvulnerable adults andflag to safeguardingleads for social careand acute hospital
Co-ordinatedapproach to dischargefor VA users to ensurevulnerability reducedwhen discharged
Expert safeguardingchampion on Unit
Learn by our ownerrors in regards tosafeguarding and bestpractice.
Users not left in ED’sfor long periods oftime reducing risks ofharm.
Avoidance of ED withdirect referral system
Thank you for listening
