74ADVANCED NURSE PRACTITIONER-LED AMBULATORY CARE FOR OLDER PEOPLE: SAFE AND EFFECTIVE

Abstract

The Rapid Assessment and Consultant Evaluation (RACE) Unit has been operational as an acute admissions unit dedicated to the needs of older patients since 2010, but analysis of patient data revealed that between 5 and 7 patients every day were having an unnecessary overnight stay in hospital to await diagnostic tests and senior medical review. The RACE Ambulatory Emergency Clinic (AEC) was set up in April 2015 to address increased emergency activity and relieve acute hospital bed pressures, aiming to assess, diagnose and treat older people without the need for overnight admission. It is managed by a team of 6 Advanced Nurse Practitioners (ANPs) supported by a Consultant, with Comprehensive Geriatric Assessment at its core. Methods: Quantitative data from the first year of RACE AEC were analysed using Quality Improvement techniques. Qualitative feedback was extracted from Friends and Family results. Results: The redesign has led to a 500% increase in clinic capacity, enabling assessment of as many as ten patients a day referred from the Emergency Department, General Practice or intermediate care, with same day access to diagnostics being the norm. 50% of patients seen would have required hospital admission had the clinic not been available, corresponding to an estimated 292 bed days saved in the first six months. There was a significant reduction in overnight admissions, and trends towards a shorter length-of-stay throughout the department as a whole. In the case of one frequent user of urgent care services, the clinic's holistic approach reduced presentations to secondary care by 75%. The clinic has attracted excellent feedback from patients and their relatives: “Excellent care - cannot be faulted” “Very friendly and efficient service. Thank you” “The Staff were caring, friendly and understanding and nothing was too much trouble. Excellent care and very professional. Thank you - 10/10” “You will never get better service than I have had today” Conclusions: The ambulatory clinic provides comprehensive assessment and investigations that historically would have required at least an overnight admission, with obvious financial and operational benefits. Patient and relative feedback has to date been very positive. Ambulatory care is a useful model for assessing and treating older patients in a timely fashion, as an alternative to hospital admission. ANPs can provide safe and effective ambulatory care for older patients.