Over 35 areas of outstanding practice at Barts Health were recognised by the CQC in its latest report. One was the new frailty pathway at Whipps Cross Hospital…
It’s Thursday morning on the Forest Assessment Unit and it’s buzzing with activity.
A pharmacist is on the phone making enquiries about medication, two therapists are meticulously reviewing their notes, while the consultant finishes checking on the last patient on their round.
They’re soon joined by a mental health specialist, two social workers and two nurses as the whole group huddle round and listen to the ward manager.
She carefully but swiftly works her way through a list of each patient on the unit, with different members of the group describing the next step of care that will help each patient recover and leave hospital.
The Forest Assessment Unit helps frail patients over the age of 65 to have a speedy recovery and avoid the kind of lengthy stay in hospital that can contribute to a longer-term deterioration in health.
Patients often come to the unit straight from A&E, and the aim is to get them well enough to return home within 48 hours. This new pathway was designed by Whipps Cross consultants Dr Luis Mieiro and Dr Simon Green, and Frailty Matron Frances McCarthy. The team says it works because of the speed that decisions are taken thanks to the collaboration with other health and care organisations.
Everyone in the team is fuelled by this collaboration and team work. Marie Collins, Ward Manager, said: ‘We have everyone we need in the same place to make decisions there and then for the good of the patient. We get together every morning and every afternoon as a group, and we make sure each patient has the right support to speed up their recovery.’
The pathway supports those patients with either short term health conditions, injuries such as falls, or those who may require additional support or therapeutic care to help them on their road to recovery. The team keep in regular contact with GPs if they identify further underlying conditions, and they’ve recently put in place a direct referral line which means GPs or colleagues in community care can discuss referrals or seek advice from the specialist team. They can also refer a patient to alternative support services that can provide them with tailored treatment for their condition, such as a memory clinic, which offers further advice for patients that may experience early memory loss or other cognitive difficulties. They also pride themselves in listening to patients so they can use the feedback to make the service better.
For every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and building this muscle strength back up takes twice as long as it does to deteriorate. One week of bed-rest equates to 10% loss in strength, and for an older person that can make the difference between dependence and independence.
That’s why Whipps Cross were so keen to grow the unit and develop the pathway. The unit expanded at the end of 2017 and now has 10 beds and four chairs for patients to use while they wait for the relevant support.
But, as became clear as the morning huddle came to an end, sometimes patients don’t even need to wait.
‘He definitely won’t need to stay here - we know the care home is waiting for his return and we can arrange transport for him to come back in for his scans.’ As the consultant finishes his sentence he receives a reassuring nod from the social worker, confirming that everything is in place in the care home, saving their patient a longer stay in hospital.
Marie said: ‘This pathway means people who don’t really need to be on an inpatient ward don’t have to go there. This can really help them recover quicker, maintaining their strength and independence. It helps the rest of the hospital too as it frees up space for people who really do need a longer stay in hospital.’
Whipps Cross has a vision to secure a redevelopment for its ageing estate and become a centre of excellence, renowned for the highest quality care for older people. The Forest Assessment Unit pathway is evidence that much of the expertise that will be needed to make that vision a reality is already at the hospital.