NHS rapid response team helps frail older patients

Against a background of an ageing population and increasing frailty, one NHS Trust has identified opportunities to provide a service targeted at this patient group. The initiative is designed to prevent unnecessary hospital admissions through the emergency front door and keep frail older people safe in their own homes. 

Emma Hibbs, Advanced Physiotherapist at Sandwell and West Birmingham Hospitals NHS Trust, explains: “We know that nationally around 50% 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 a Rapid Response Therapy Service (RRTS) to provide urgent assessment of frail older patients coming into our emergency departments (ED). The service ensures they receive appropriate care, 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 persons assessment units. The service operates from 8am to 8pm, seven days per week with a 10-minute response time to ED bleep referrals.”

The RRTS team uses 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 the Trust’s 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, with an admission prevention rate of 92% for frail older people and an overall increase in therapy activity of 41%.

“With early access to comprehensive therapy assessment and discharge planning for patients through a home first mindset, 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.”

Mr Jonathan Fellows, Chair of the Black Country and West Birmingham STP, commented: “With the number of people aged 65+ expected to grow over the next 10 years, we need services to rethink the way that they work. It is vital that we do all we can to ensure that the most frail and vulnerable in our communities get the support they need, especially when they find themselves attending one of the local hospitals.

“This great example, from Sandwell & West Birmingham Hospitals, is ensuring that those most vulnerable in our community are seen quickly and are returned to independence as soon as possible.”