Heartbeat: Rapid response team targets frail older patients

March 11, 2020

Against a national background of an ageing population and increasing frailty, our therapy colleagues have identified opportunities to provide a service targeted at this patient group. The initiative is designed to prevent unnecessary hospital admissions through our front door and keep frail older people safe in their own homes.

Emma Hibbs, Advanced Physiotherapist explains: “We know that nationally around 50 per cent of the population aged 65+ live with some degree of frailty. Our population is diverse, and experiences high levels of deprivation, with a reduced life expectancy. And, the number of people living with dementia is expected to rise vastly by 2030.

“To meet the demand of older patients, we created our Rapid Response Therapy Service (RRTS) to provide urgent assessment of frail older patients coming into our emergency departments to ensure they receive the most appropriate care for them, including avoiding admission where possible and providing ‘wrap-around’ community support.

“The integrated team is made up of physiotherapists, occupational therapists and assistant practitioners covering the emergency departments, acute medical units and older person assessment units for 12 hours a day from 8am to 8pm, seven days per week with a 10 minute response time to ED bleep referrals.”

The team uses proactive screening and identification of patients for therapy intervention and aims to divert demand from acute services where appropriate. Early access to comprehensive therapy intervention and proactive use of community and voluntary services to support discharge delivers a reduced readmission rate, as patients are safely cared for out of hospital. Patients who require admission are assessed and an individual plan for their care is drawn up to allow discharge as soon as medically appropriate.

Nuhu Usman, Acute Medicine Consultant and Clinical Director of Emergency Care added: “On forming the rapid response team we had several ambitions, including reducing the numbers of frail older people who are admitted from 24-hour care, reducing length of stay for those patients, delivering a reduced readmission rate and a reduction in four-hour breaches.

“The team has received positive feedback from colleagues across our emergency department at Sandwell, and an admission prevention rate of 92 per cent for frail older people coming into Sandwell ED, with an overall increase in therapy activity of 41 per cent.

“With early access to comprehensive therapy assessment and discharge planning for patients through a ‘home first’ mind set and a substantial increase in onward referrals made to other community services in the voluntary sector and social services, we can see the difference the team has made.”