A beacon of care for our elderly

A beacon of care for our elderly

2 November 2016

A NEW service being pioneered at the Downe Hospital could be rolled out to other hospitals across the Province.

Launched as a pilot project exactly one year ago, the rapid assessment centre has been designed to improve patient care for the district’s frail elderly population by taking them away from what can at times be a busy and noisy emergency department 

to a quiet ward on the first floor of the hospital.

There, they can have treatment and access to a full range of diagnostic tests and various health professionals. One local GP practice is currently referring patients directly to the assessment centre and doctors and nurses who provide the service are planning to meet with all of the district’s GPs early in the New Year to provide an overview of the service and explore the potential for expanding it.

Staff at the Downe are keen to redesign services to meet the needs of the district’s ageing population and those referred to the rapid assessment centre are either discharged and returned home following treatment with a care plan in place or admitted for further treatment.

Dr Cahal Foy, the centre’s lead clinician, said staff are keen to expand the service and are up for new challenges to provide an even better service, looking at new ways of working and utilising new equipment.

The rapid assessment centre opened with just four beds, but the number was increased to six to improve service provision and it is hoped bed numbers can be increased to eight.

“We are innovative and keen to expand the service we provide,” Dr Foy continued. “There is a recognition that traditional emergency departments are not good for elderly patients as they are in with a mix of lots of other patients, often in a very busy, noisy and in many ways medically aggressive environment. These departments can be a frightening place for the elderly.

“The rapid assessment centre enables them to be taken away from this environment which also helps the emergency department as bays are not being tied up for long periods of time by elderly people with a range of frailty problems who can take a long time to be assessed. 

“Our centre is a much kinder environment for them where they can be assessed and we can decide to treat them and subsequently ready them for discharge to their homes where they would much rather be, or admit them.”

Dr Foy explained elderly patients who arrive at A&E are currently triaged by a nurse and if they are clinically stable they are highlighted to doctors as suitable for referral to the rapid assessment centre. He said plans are in place to improve the referral to get elderly people to the centre even more quickly.

The centre is currently open five days a week between 9am and 6.30pm but staff hope its operating hours can be extended and that it could open seven days a week.

“There is potential to move to a seven-day service, but we are currently focusing on a five day service and making sure there is medical and nursing cover alongside that. Expanding the service would further ease the pressure on the Downe’s emergency department,” continued Dr Foy.

“We are a first and we are unique and while some other health trusts have versions of a centre which is similar to ours, it is not quite the same model. We are innovative and, crucially, delivering service improvement. There are also plans to roll out the rapid assessment centre provision to the Lagan Valley and Ulster hospitals.”

The Downe clinician believes the rapid assessment centre fits with recommendations in the Bengoa Report launched last week outlining how hospital services should be redesigned to make them fit for the 21st century, adding: “Feed back from patients on the service we provide has been excellent and we are keen to expand what we provide.”

Sister Emma Cullen, who manages the rapid assessment centre, said around two thirds of the patients referred to it are discharged, suggesting the stay in hospital of those admitted from the unit is generally shorter than those admitted to wards from A&E.

“From the day we opened, we have asked people referred to us to complete a patient satisfaction survey which overwhelmingly endorses what we are doing here. We recently won the South Eastern Trust chairman’s prize which we are all delighted about. Patients can see the difference it makes coming here as they have direct to specialist nurses and consultant staff,” she continued.

“One GP practice directly refers patients to the centre and we will be meeting with other local GPs in the area in January to discuss opening up the service to them. We are simply providing an improved service for elderly people who do not have to wait in the A&E department. The service we provide has been tweaked as it progressed and patients referred to us have access to all the hospital’s professional staff and there is a lot of goodwill across the Downe for what we do.”

Emma said the centre has access to the hospital’s x-ray department including a CT scanner and to staff who provide ultrasound scans, cardiac investigations, physio and occupational therapists and social workers.

She added: “I am very enthusiastic about this service was always confident it would work. I have been at the Downe for 15 years starting as junior staff nurse before spending 11 years in coronary care and three years working as a bed manager. I could see where we were falling down in relation to frail older care and knew there were things that we could do to help to alleviate service pressures  and look after older people not keen about entering a busy hospital environment.

“We are living in an era of a growing elderly population and what we are doing is trying to bridge the gap between primary and secondary care. We believe the innovative rapid assessment centre is an important part of future service delivery at the Downe Hospital, meeting the needs of a growing elderly population.”