A new multidisciplinary team in Morriston Hospital is helping keep elderly patients as active as possible in a bid to make their stay as short as possible.
Research shows that the longer a frail patient remains in bed, the harder it is for them to get back on their feet again and resume normal routines necessary to stay independent.
The therapy assessment unit – made up of occupational therapists, physiotherapists and clinical nurse specialists for care of the elderly – is based within the hospital’s acute medical unit (AMU) to assess patients for discharge home.
To support a patient’s timely and effective discharge the team works closely with experienced colleagues in the hospital’s Older Person’s Assessment Service (OPAS) to safely get people home, prevent them from deconditioning and regain their independence.
AMU, itself newly introduced to Morriston, acts as the gateway between a patient’s general practitioner, the emergency department, and the wards of the hospital.
Sarah Morse, Clinical Lead for Occupational Therapy Services in AMU, said: “When people come into hospital they can decondition because they are out of their usual environment and routines.
“We try and get them out of bed, get them dressed and try to get them to do the normal things they normally do.
“By doing these tasks they hopefully get home a lot quicker.
“At the forefront of the whole programme is ‘home is always first’ – we will do everything we can to get you home.
“People can deteriorate fairly rapidly if they spend too long lying in bed. So the less time spent in hospital the better.
“The unit is designed to assess patients early enough to get them turned around and back home rather than be admitted to a medical or long stay ward.
“But we always make sure that the patient is included in the decision.”
It’s not just the therapists, we all can play our part as discharge is everyone’s business.
Sarah said: “It’s about educating family as well that once they come in they will be going back home. A lot of people come with their pyjamas packed, but we say, ‘You don’t always sit in your pyjamas all day so bring in your clothes.’ To make it as normal as possible.
“The evidence shows that this prevents deconditioning and reduces a patient’s length of stay.”
The unit has a therapy room attached to it where the team can assess a patient’s aptitude to carry out everyday tasks.
Sarah said: “We have parallel bars, a stairs assessment, a bathroom and bedroom, as well as a kitchen assessment area.
“They help to show if someone is physically and cognitively safe to return home.
“Having the therapy assessment unit attached to AMU enables us to complete timely assessments which supports the turnaround of discharges.”
A recent addition to the process arrived in the form of a new freezer.
Sarah said: “Wiltshire Farm Foods kindly donated a freezer to us so we can store frozen meals. Now, instead of just making a cup of tea with patients we can make a meal with them.
“It’s all evidence to show the patient and family that they are coping well and able to carry out task safely. So when they go home they can manage their activities of daily living.
“If someone isn’t suitable to go home there are a range of options. If they are not medically well enough they will go to a ward appropriate for them, if they are waiting on a package of care we will get them to a clinically optimised ward where they can wait in a different environment where people are medically stable and there is less risk of infections. If not they will go home.”
Once they return home patients are far from forgotten about.
Sarah said: “We use community services, virtual wards and acute clinical teams to try and support people back into the community.”
The majority of patients admitted to the unit are elderly and often live with dementia.
Dawn Jones, an occupational therapist technician, said: “They can become quite distressed – they are out of their own home and it can be quite noisy on the ward.
“As it’s very busy in the unit we can get radios from the library service and have headphones on to help them chill out.
“To make someone’s journey through hospital a more pleasurable and easier one is absolutely fantastic. It’s such a benefit to see.
“I go around with the library trolley. A lot of patients can be sat there for hours and hours with nothing to do. With visiting being quite restricted at least we have books and magazines that we can pass on to them. Anything to keep them active really.
“We have also contacted Swansea Whizz Knits to make to make twiddle muffs for our patients with cognitive impairments.
“They have buttons and twiddles sewn on to keep their hands and minds distracted, rather than been distressed on the ward. The evidence does show that they settle patients down.”
Dr David Burberry, Clinical Lead for Acute Medicine, said: “We are doing twice daily ward rounds to try to assess people as they come through with a larger MDT approach to ensure we are giving people a comprehensive assessment earlier so we can try and deal with any problems as they are coming in, including medical problems, so we can try and discharge people more quickly.
“We’ve been seeing that in a reduced length of stay coming through the short stay unit ward compared to previous setups.”
Dr Burberry also praised the measures taken to help people living with dementia.
He said: “Having therapists interested in dementia, we felt was important, because it helps deconditioning of the patients within the unit. We are quite keen to implement things that we know will help improve outcomes.
“We’ve changed clocks, and have twiddle mitts available in the frailty section, and we have a group of people within the community knitting them for us so we can give them out to patients who come in a bit confused, to give them something to distract them with.”
