Heartbeat: Frailty at the Front door – an insight in to Advanced Clinical Practice

May 27, 2021

Establishing a front door frailty service has been a focus at SWB in recent years, last year saw two notable events; the creation of the first frailty specific trainee Advanced Clinical Practitioner (tACP) role and the first phase of the ED ‘Frailty Intervention Team’ (FIT). An unlikely duo of opportunities in such a challenging year.

The Rapid Response team has long been an established integrated therapy service at the front door, but in 2019, we began a therapy led enhanced service project in ED. It aimed to provide a proactive comprehensive assessment to prevent admissions and early intervention therapy, for those whereby a decision to admit was made. The pilot was a great success and from this, the ACP role was created, which was soon out for advert later in the year. I was very fortunate to be successful in obtaining this exciting role and commenced it in it early 2020.

Frailty as we know, is multifaceted and a speciality that requires a high level of assessment and management skills alongside complex problem solving abilities. The comprehensive nature and breadth of application lends itself well to an ACP that can assess multiple components, if not most of a comprehensive geriatric assessment. The primary presentation of a fall in an older adult naturally lends itself to an advanced physiotherapy assessment and places our profession at the forefront of frail older adult care.

So, why advanced clinical practice? On a personal level, there were many reasons for this. I’m a physiotherapist at heart, and I have been fortunate enough to work across many areas from sport to acute NHS rotations and I chose to specialise in front door based work. My previous role was the rapid response team Lead and what I enjoyed most about this was the teaching, education and leadership responsibilities. However, with rotations, this bought lots of repetition and I’d reached a point where I wanted a new clinical challenge. Having worked in ED for many years amongst extended scope practitioners, the role appealed to me but MSK wasn’t my clinical interest.

Advanced practice was an area I hadn’t really come across until a few years ago. However, when we were providing an enhanced therapy service in ED, at times I became frustrated that I was limited within my physiotherapy remit. For example, with presentations after a fall, ruling out injury or acute illness and prescribing/de-prescribing, I could see that an advanced practice role would improve outcomes for patients with the benefit of it being one clinician. I have always been interested in understanding the medical model and could see the benefits of being an ACP; I could do so much more for the patient with the advantage of having Physiotherapy at the core. When I researched further into the world of ACP, the four pillars immediately resonated with me (clinical practice, leadership and management, education and research), as they combine all of my interests into one job, so when the frailty tACP post became a reality, I jumped at the opportunity.

We launched the ED frailty intervention team in July, and it continues to evolve into a multi-disciplinary team delivering comprehensive geriatric assessment. I’m fortunate to work with a team that is supportive, nurturing and have a network of people around me helping me on my ACP journey. Whilst the COVID-19 pandemic posed and continues to pose many challenges, it was opportune that such a team could be created to integrate and work alongside our ED colleagues. It’s already demonstrating measurable impact, not only with patient outcomes but helping to relieve the pressure of increasing presentations and admissions to hospital. As well as helping to identify and address all of the unfortunate consequences that shielding, isolation and multiple lockdowns has had on our local population with increasing frailty, falls and associated deconditioning. The future vision of this frailty team is that it will be led by a team of ACPs.

As I sit here writing this on the 1 year anniversary of starting my role, reflecting back and whilst it hasn’t been a ‘typical’ year, it’s been one full of challenges to learn from and grow. It’s an exciting time for advanced practice, both nationally and locally at SWB. Whilst we are still in the midst of the pandemic, we are continuing to build and embed the work of the frailty team. Alongside this, there is an evolving ACP response across the Trust creating opportunities across the MDT inclusive of Physiotherapy. This is a chance to really showcase the talents of our profession in advanced practice roles.