294Working Differently to Greatly Improve Care for Frail Patients Attending the Emergency Department

Abstract

Background: Recognising the often complex medical, functional and social care needs of frail older patients presenting to the Emergency Department provided the impetus to improve the care model at the front door. In line with best practice, the principles of A) early identification of need and B) early initiation of treatment were adopted by establishing the Frail Intervention Therapy (FIT) Team in the Emergency Department (ED). The team comprises Physiotherapy, Occupational Therapy, Medical Social Work, Speech &Language Therapy, Dietetics and Pharmacy. Following an interdisciplinary approach to care, within one hour of presentation to the ED, the team assesses all patients over 75 years to determine their treatment needs and the appropriate care pathway. Method(s): The team developed a common screening tool to identify the appropriate care pathway i.e. admission or discharge. Working with medical and nursing colleagues, patients deemed suitable for admission are fast-tracked to the Specialist Geriatric Ward or alternatively, those appropriate for discharge are offered follow-up home therapy. Result(s): Patients suitable for admission receive therapy from the FIT team on their day of presentation. Once admitted, handover is provided to the in-patient Health and Social Care Professional team, thereby avoiding delays thus leading to better outcomes, including reduced readmissions, reduced long term care and lower costs. Encouragingly, in 2016, early initiation of treatment led to a 33% increase in patients being discharged home rather than converting to long-term care. Furthermore, during a five month period in 2016, 6% of patients (55 patients) were successfully discharged and maintained at home (at 30 days), saving over 800 bed days. Conclusion(s): This successful model has been replicated nationally in 2017. Furthermore, the outreach model has been instrumental in informing the design of the National Integrated Care Teams due for establishment this year supported by the Integrated Older Persons' Clinical Care Programme.