Emma Green is the team leader of the occupational therapy (OT) department at Tauranga hospital, in the Bay of Plenty, NZ. As an OT, Emma has over 15 years of experience in various speciality areas which include intermediate/transitional care, rehabilitation for older adults, stroke and acute trauma with a number of DHBs and NHS trusts. With a keen interest in transdisciplinary working and the development of allied health teams towards responsive models of practice, Emma has been involved in various service improvement projects at a DHB level that have promoted inter-professional collaboration. This includes the DHB’s acute flow programme with initiatives aimed at improving the journey for frail elderly within the acute hospital setting.
Rosie Winters is a Nurse Practitioner Older Adult with the Bay of Plenty District Health Board in New Zealand. With 14 years of specialty experience working within the Older Adult area of practice in education, leadership, and advanced clinical practice, Rosie has focused on in improving acute care of the older person through her clinical practice work and is committed to service improvement initiatives at local, regional and national levels. Rosie has a keen interest in both frailty and in developing and promoting inter-disciplinary team (IDT) functioning. Over the past year, Rosie has been instrumental in developing and continually improving a process for early identification and IDT assessment of Patients At Risk of Increased Stay (aka PARIS) in Tauranga Hospital as part of the DHB’s Acute Flow Improvement Programme, resulting in a 20%+ decrease of stranded patients aged 75 or more.
Interdisciplinary Approach To Frailty At The Front Door
“If you only had 1000 days left to live how many would you want to spend in hospital?” The importance of not wasting our patient’s time and optimising the acute patient journey through hospital particularly for the frail and elderly has been a focus of the Acute Flow Improvement Project within Tauranga Hospital for the last year.
• Patients aged 75+ occupy over 60% of inpatient beds
• Patients aged 75+ account for over 50% of the stranded patient metric
• This group of patients is most at risk of deconditioning and longer stays in hospital
The PARIS (Patient’s At Risk of Increased Stay) process was developed in response to an identified need to enhance the quality of care and timely access to care for frail and elderly patients presenting to hospital, and to improve acute patient flow through the hospital for this group of patients. Prior to November 2016 a traditional multi-disciplinary referral system was in place in the ED or APU, and there was no screening of frail and elderly patients. This has been replaced with a pro-active, ‘live’ triage process enabling the inter-professional team to respond rapidly to the needs of the older person in ED or APU. The model for improvement was utilised to initiate and embed the change process.
Results have demonstrated a sustained and significant reduction in length of stay, time to assessment and improved work satisfaction for the members of this team. In partnership with the APU team we have achieved
• a 10 hour reduction in APU length of stay for patients 75+
• a 20% increase in patients 75+ with length of stay <36 hours
• 3000 bed days saved