48 Specialist Physiotherapist Leading in the Frailty Revolution in Ambulatory Emergency Care at the John Radcliffe Hospital, Oxford

Abstract

Abstract Background The Ambulatory Assessment Unit (AAU) at the John Radcliffe Hospital aims to provide excellent care for complex patients with varying range of medical presentations. It sees over 50% of the acute take in operational hours, with over 40% of AAU patients over the age of 70. Staff feedback consistently identified a suboptimal service provided to the frail group within this patient cohort. A dedicated physiotherapist specialising in older people living with frailty joined the team in October 2018 to address this. Aims Early identification of patients with frailty attending the unit Improve staff understanding of frailty to enhance patient care Assess patients to either enable a patient to return home safely or support ambulatory pathway Refer to community services that can support the patient and enable them to live well after hospital attendance Review the impact of the specialist physiotherapist’s role Methods Introduction of frailty identification as per frailty team guidance Frailty questionnaire to ascertain baseline understanding and learning needs to develop staff training Assess patients using a Comprehensive Geriatric Assessment Raise staff and patient awareness of community support services available within the community Data collection to review interventions taken, bed days saved and re-attendance rates Results 129 new patients were seen in a 4-month period. 85% returned home the same day; 64% had their ambulatory pathway supported with therapy intervention and 21% had an acute admission avoided directly due to therapy. 15% were admitted to an acute bed for safety 60% of patients were referred to community services and 50% were signposted to a range of community and support services The re-admission rates for therapy related reasons within 7 days and 30 days were 0% and 4% respectively. 38 bed days were saved with a calculated cost saving of £15,162 Future service delivery and conclusions There is ongoing work to obtain patient experience data for those who had their admission avoided directly due to therapy intervention. A training programme on frailty for all members of the MDT is to be developed. A dedicated therapy service in an ambulatory setting has a role in ensuring that patients’ needs are met in the most appropriate place and enhances their quality of life after hospital attendance.