Frailty Team

FRAILTY TEAM

Care of the older person is most effectively delivered through multidisciplinary teams and so the Rapid Assessment Frailty Team Tullamore (RAFTT) was established in January 2018. It comprises a senior Physiotherapist (PT) and Occupational Therapist (OT).

The main aim of the RAFTT is to review all frail patients over 65 who are for same day discharge and to start early discharge planning for any patients who are lodged who present to the ED during core hours (Monday – Friday, 9 – 5pm). The vision for the RAFTT service is to enable and facilitate a safe and coordinated discharge for all frail elderly patients from the ED and provide early intervention to assist patient flow and a positive patient experience.

AIMS OF THE RAFTT

• To provide timely, multidisciplinary, comprehensive geriatric assessment (CGA) and intervention by senior decision-makers for older frail people attending the ED.
• To facilitate safe, co-ordinated, yet rapid discharge from ED attendance to home or hospital admission and reduce multi-attendances to the ED.
• To improve patient flow through the frailty pathway and to commence therapy in the ED.
• To improve patient experience within ED and across services.
• To reduce length of stay (LOS) in patients seen through early referral and identification of patient care needs (LTC, home care packages etc.)
• Enhanced integration with community services to ensure appropriate care and non-acute medical intervention was provided to older people in their own homes.

The key roles of Physiotherapist and Occupational Therapists in the Emergency Department

The PT and OT are a core part of the ED, due to their professional roles of assessment and rehabilitation of mobility and function. Therefore, key in facilitating timely, patient-focused holistic assessment and intervention for patients who are frail, elderly and or complex in functional and social care needs. The unique assessment skills that the RAFTT deliver should therefore aid rapid risk assessment, support timely decision-making and as appropriate early or same day discharge planning.

By providing prompt expert, skilled and proficient assessment at the front door the therapists directly contribute to reducing the length of stay of patients who do not require inpatient hospital stay, improving the patient’s journey by either facilitating early discharge or providing early therapy goal-setting intervention at the start of the hospital journey.

Onward referrals to community services or supports are rapidly generated and provide on-going therapy intervention and support same day discharge. The quality of care and support for this patient group is safer, fair and patient centred by integrating services and promoting care at home.

Referral Criteria

The ‘Think Frailty’ tool is used to target patients who are most likely to benefit from a referral to the RAFTT. By triggering early intervention, there is potential to significantly improve quality and effectiveness of care in the acute setting (NHS Scotland 2014). It will also improve the identification and management of frailty.

Would this patient benefit from a frail elderly assessment? If answer is yes to 1 or more then the patient requires assessment by the RAFTT.

Referral Criteria

• Falls (even if independent)
• Functional Impairment/Reduced mobility
• Multi – morbidity
• Poly – pharmacy
• Confusion – acute/chronic
• Reduced ability to carry out ADL’s
• MSK assessment
• Respiratory Assessment
• Brace/ Splints
• ADL equipment for home e.g.  raised toilet seat/wheelchair/crutches
• Nursing home resident
• Complex social situations e.g. Query regarding care provided at home