Chief Allied Health Professions Officer’s Conference 2016 Workshop 1: Urgent and emergency care – Chair Helen Marriott The Early Intervention Team (EIT) based in A&E preventing admission. Gareth Blissett, Team Lead, West Suffolk NHS Foundation Trust.

1. Early Intervention Team
Responding to Urgent and Emergency
Care in West Suffolk

3. Context
• Increasing ED attendances (DOH, 2014)
• Growing older population and number of patients with
complex conditions (West Suffolk CCG)
• Poor outcomes:
– long hospital admissions (Alzheimer’s Society
2009)
– English and Paddon-Jones (2010) reduced muscle
strength after hospital stay in older people
• Early Intervention Team (EIT) (Occupational Therapy
and Physiotherapy) based in ED and AMU Monday to
Friday 8:30- 16:30
• Referrals on to Social Services and voluntary sector

4. Drivers for change
• Needed changes to patient flow and
admission avoidance (NHS
Confederation 2016)
• Consultants requesting EIT at
weekends and later on weekdays, as
patients are not requiring acute medical
treatment
• Better coordination for patients with
frailty (BGS and RCN, 2015)
• Reduce hand- offs, improve rapid
access to services
• Push model out into the community,
challenge ED attendances

5. Starting point
• Initial trial of extended hours and voluntary
weekend working in ED and AMU
highlighted able to discharge patients but
needed support from Social Services
• Task and Finish Group with key partners
• Applied for funding from West Suffolk CCG
to enhance current team

6. Opportunities identified
• Integrated working between health, social care and voluntary
sector (NHS Five Year Forward Plan, 2014; Oliver et al 2014)
• Support from geriatricians, need to link up with community
services
• Improved patient experience, promote reablement
• Reduce conveyance
• Cost avoidance for length of hospital stay, improve long- term
health (Alzheimer’s Society, 2009; English and Paddon- Jones
2010)
• Increased role of AHPs

7. Aims and objectives
• Phase 1 November
2013
– Reduce acute
admissions through
admission avoidance in
ED
– Reduce length of stay
on AMU
– Integrated working

8. Aims and objectives
• Phase 2 November 2015
– Community admission avoidance
– Reduce ED conveyance
– Integrate with Admission Prevention nursing service
– “The clinical audit at West Suffolk Foundation Trust in
December 2014 identified that a significant proportion
of the admissions were underpinned by frailty with
respiratory, urinary tract infections and falls being a
trigger’” The West Suffolk 2014/15 Winter Review

9. Method and approach
• Phase 1 November 2013
– Extended hours, 7 day service
– Integrated team, wraparound service
• Therapies (West Suffolk NHS Foundation Trust)
• Age UK Suffolk
• Suffolk Social Services
• Dementia liaison nurse (Norfolk and Suffolk NHS Foundation
Trust)
• Carers (Crossroads East Anglia)
• Access to Geriatricians

10. Method and approach
• Phase 2 November 2015
– Extension of integrated team:
• Colocation of Admission Prevention Nursing Team
(Suffolk Community Healthcare)
• Reablement support workers (carers) in- house
• Suffolk Family Carers link worker
– Promotion of team to GPs, Ambulance Service,
Social Services, community health teams, housing
associations, hospice

11. Successes
• Improved communication, integrated team in
same office
• Shared learning
• In ED became part of the core team,
improved relationships and respect
• More power
• Increased referrals in ED and increased
discharges
• Discharge to assess model
• Reablement focus

12. Barriers
• Different IT systems and governance
agreements
• Delays in handing over for on- going care
• Delays in Continuing Healthcare
• Office space
• Out of county patients in ED

13. Service outcome measure
• EIT intervention impact score results for patients seen in
January 2016 in ED, CDU, Fracture clinic and AMU
Category Descriptions Frequency Percentage
0 - No change 12 7.9%
1 - Unavoidable admission (Medically unfit) 30 19.9%
1a - Unavoidable admission (No intermediate care) 1 0.7%
1b - Unavoidable admission (No Care package) 1 0.7%
1c - Unavoidable admission (No respite bed) 0 0.0%
1d - Unavoidable admission (Vulnerable adult) 0 0.0%
1e - Unavoidable admission (No transport) 0 0.0%
1f - Unavoidable admission (Unable to contact
home) 0 0.0%
1g - Unavoidable admission (Patient anxiety) 0 0.0%
2 - Facilitate safer discharge 39 25.8%
3a - Admission avoidance 62 41.0%
3b - Admission avoidance (Intermediate care) 5 3.3%
3b - Admission avoidance (Respite care) 1 0.7%
3b - Admission avoidance (Hospice) 0 0.0%
Total patients 151 100%

14. Results and evaluation
• Exceeded KPIs in first year for ED and AMU
– December 2012- April 2013: 360 avoided admissions
and early support discharges
– December 2013- April 2014: 777 avoided admissions
and early supported discharges
– December 2014- April 2015: 971 avoided admissions
and early supported discharges
– December 2015- April 2016 1559 patients seen in the
community, 804 avoided admissions and early
supported discharge

15. Results
• Qualitative- Positive feedback from patients, families,
health and social care providers
• Improved wraparound service, holistic assessment/
comprehensive geriatric assessment. Efficient “one- stop
shop”, rapid access
• Cost avoidance for reduced conveyances, health
promotion (£1078 average admission tariff)
• Need further promotion to GPs and Ambulance Service
to increase community admission avoidance

16. Key learning points
• Team adapting to change
• Managing expectations
• Coordination
• Data collection from different organisations
• Promotion to public and primary care
• Value of AHPs in urgent care

17. Plans for spread
• Further integration with GPs/ Ambulance Service
• AHPs to triage in ED
• 24 hour reablement support worker service
• Entered HSJ Awards
• NHS England (2016) rehabilitation
commissioning guidelines
• Promotion to patients to not attend ED
• Training opportunities- ? X- ray requests ?
Prescribing

18. Follow us!
• Twitter: @WSH_EIT
• Youtube: https://www.youtube.com/watch?v=m76CkAn7JC4
• Website:
http://www.westsuffolkccg.nhs.uk/clinical-area/clinical-workstreams-and-cu
/

19. Thank you!

20. References
• Alzheimer’s Society (2009) ‘Counting the cost: Caring for people with dementia on hospital wards’
[Internet] Available at: https://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=787
• British Geriatrics Society and Royal College of Nursing (2015) Fit For Frailty [Internet] Available at:
http://www.bgs.org.uk/index.php/fit-for-frailty
• College of Occupational Therapists (2015) Urgent Care: The Value of Occupational Therapy
[Internet] Available at:
https://www.cot.co.uk/sites/default/files/general/public/Urgent-Care-report-2015.pdf
• English, K.L and Paddon- Jones, D (2010) Protecting muscle mass and function in older adults
during bed rest. Current Opinion in Clinical Nutrition and Metabolic Care 13(1) p. 34- 39
• NHS England (2015) What actions could be taken to reduce emergency admissions? [Internet]
Available from:
http://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-admissions.pdf
• Kings Fund (2010) Avoiding hospital admissions [internet] Available from:
http://www.kingsfund.org.uk/sites/files/kf/Avoiding-Hospital-Admissions-Sarah-Purdy-December2010.pdf
• Lord- Vince, H et al. (2014) The need for a 7- day Therapy Service on an Emergency Assessment
Unit. British Journal of Occupational Therapy 77 (1) 19- 23
• Nhs Confederation (2016) Growing Old Together: Sharing new ways to support older people
[Internet] Available at:
http://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Growing%20old%20togeth

21. • NHS England (2016) Commissioning Guidance for Rehabilitation March 2016 [internet] Available
from:
https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf
• NHS England (2014) The NHS Five Year Forward View [internet] Available from:
https://www.england.nhs.uk/ourwork/futurenhs/
• NHS England (2015) What actions could be taken to reduce emergency admissions? [Internet]
Available from: http://www.england.nhs.uk/wp-content/uploads/2014/03/red-acsc-em-
admissions.pdf
• Oliver, D. (2015) ‘Integrated services for older people- the key to unlock our health and care
services and improve the quality of care?’ Journal of Research in Nursing 20 (1) 5- 11 Available at:
http://jrn.sagepub.com/content/20/1/5.full.pdf+html
• Oliver, D, Foot, C and Humphries, R (2014) ‘Making our health and care systems fit for an ageing
population’ The King’s Fund [Internet] Available at:
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/making-health-care-systems-fit-
ageing-population-oliver-foot-humphries-mar14.pdf
• Wilson, A et al. (2015) Establishing and implementing best practice to reduce unplanned
admissions in those aged 85 years and over through system change [Establishing System Change
for Admissions of People 85+ (ESCAPE 85+)]:a mixed-methods case study approach. Available
at: http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0020/151337/FullReport-
hsdr03370.pdf