Safely Reducing Avoidable Conveyance Programme

Reading Falls and Frailty Project

Brief Description of Initiative

The initial concept of the Reading Falls and Frailty Service (FFR) was started in 2015 and was part of a service improvement project devised and run by one of our Specialist Paramedics. The project is a collaborative project working with Occupational Therapists (OT) from Royal Berkshire NHS FT. The SP and OT work together and use their combined skills to travel to, assess, treat, arrange referral if required and give aftercare advice.

The service has developed and evolved over the years. The service hosted a further Service Improvement project run by another of our SPs where Point of Care Testing was carried out.

The Service now runs 3 days a week 0700-1900. Calls are taken directly from 999 and 111 calls and also from Crew referrals. The Crew scan iNet viewer and identify calls and request direct dispatch from the control room. Dispatchers and CSD can call the crew and triage calls directly with the SP or OT.

The scope of the service is patients 65 and over, fallen or at risk of falls =/- frailty. We also accept calls from other vulnerable groups at risk of falls for example Multiple Sclerosis patients (adult but under 65). The address of the call must be within the Royal Berkshire Hospital referral area.

The Service has developed over the years and there is a focus on Frailty and working with the Team of Frailty Practitioners at RBH FT. The Occupational Therapists have also developed a system of streamlining admissions at the Front door of ED which in turn means that the process through the department is quicker and smoother for the patient resulting in a safe discharge earlier whether that be on the day or following a short stay.

Date Initiative was introduced in Trust

12th September 2015.

Date of upload or review

Uploaded to Repository 1st January 2020.

Background Context

The initial context/concept of the project is viewed as:

“The FFR will consist of a multi-disciplinary team (MDT) of a specialist paramedic (me), and an advanced specialist occupational therapist from the ED/AMU team of the RBH. Together we will select incidents from the incoming call stack, or take referrals from crews, and respond primarily to patients over the age of 65 who have fallen (with or without injury), but also to those displaying the geriatric syndromes of immobility, confusion, dizziness or feeling generally unwell.

Once on scene this MDT have the potential to assess and treat underlying illness, assess and close/treat minor wounds/injury, perform assessments of mobility, function and cognition. Then if needed we will be in a position to equip patients with mobility aids, commodes, pendant alarms and non-slip footwear. The patient will also be assessed for frailty and with the OT’s community links, further help and emergency support can be arranged with the help of other community teams.”

Which specific patient group or presenting need is this response targeted at?
  • Fallers / those at risk of falls,
  • The frail,
  • Over 65’s.
Geographical area or location covered by this response model

Royal Berkshire Hospital receiving area  – West Berkshire predominantly, extending to parts of Bracknell/South Oxfordshire for acute first time fallers.

Key Aims

The priorities of the project are:

  • Patient care
  • ED avoidance
  • Additional Referral pathways accessed by Occupational Therapists.
Benefits for Patients
  • Right help first time
  • Avoids admission
  • Prevention of further falls
  • Patients feel supported and that they have received a response specific to their needs.
Benefits for Trust or System
  • Reduction in future calls
  • Reduced admission rates
  • Reduced ED attendances
  • Pre warning of attendance at ED to Frailty Practitioners which reduces time in the department
  • Cost effectiveness, as reduces future demands on the wider service
Implementation

How long has this initiative been operational?

  • 4 years

Days / Hours of operation:  

  • Saturday, Sunday, Monday 0700-1900.  (Last year we had a 3 month period of 7 day cover with the addition of 0700-1700 service Tuesday-Friday. This ran from Jan to March inclusive.

Which clinicians are involved in the response and how many WTEs (if a specific cohort)?

  • 2 Clinicians. One SP or Trainee SP and one Occupational Therapist.

Which other partners are involved in providing the response?

  • (See above

What other key resources are needed for this response to work? (vehicles, specific equipment etc.)

  • Specific vehicle able to carry the OT equipment required. This equipment can be placed with the patient immediately.

How is the initiative funded? (level of engagement/support from CCGs etc.)

  • CCG Funding.

What were the main facilitators / blockers / interdependencies when introducing this response?

  • Funding
  • Availability of SPs/OTs.
Evaluation & Monitoring

What are the key success measures?

  • Patient numbers
  • ED avoidance
  • Demographics

How are these being measured / collated / monitored?  (Frequency / who reported to etc)

  • Data capture via primary recording of events as they occur.

Has a formal evaluation process been undertaken (independent / in-house)?

  • The service was evaluated at the end of both Service Improvement project and moved from an initial trial to a business as usual project that runs as part of both the SCAS SP service and the RBHFT Occupational Therapy Department.
Sustainability

Does the Trust intend to continue with this response for the foreseeable future?

  • Yes.

What long-term resourcing requirements are there?

  • Staffing and Vehicles

What risks have been identified (for patients / trust / system) in providing this service and how have these been mitigated?

  • The service does not run every day. The service received is variable dependent on day of the week and response available.

Is there potential to expand this response model?

  • Yes.
Sharing & Learning

What has the Trust learnt most from introducing this process?

  • Patients that receive immediate help for falls/risk of falls/frailty are less likely to fall subsequently. A comprehensive and MDT response at the time of the fall has a greater impact that the individual teams having input to a patient at different times. (Falls referral – patient seen by Ambulance response, Falls referral made, – patient may or may not receive a further assessment sometime in the next 3 months.).

What might be done differently with the benefit of hindsight if implementing again? (in another part of the Trust for example)

  • Ensure the correct vehicles are available prior to implementation.
  • Consider Point of Care testing as an integral part of any Falls/Frailty service staffed by Band 7 Ambulance clinicians and Band 7 Occupational Therapists with a Medical referral link available to discuss results.
  • This follows on from work not only with this project but also in other Falls and POCT projects across the Trust.
Additional Information

Wider, contextual information about SCAS’s Urgent Care Pathway Improvement Programme is available to download here.

ScHARR Evaluation

This Initiative has been the subject of an evaluation review by ScHarr – read the report here.

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