A long way from Frome: improving connections between patients, local services and communities to reduce emergency admissions.

BACKGROUND: Low socio-economic status can lead to poor patient outcomes, exacerbated by lack of integration between health and social care and there is a demand for developing new models of working. AIM: To improve connections between patients, local services and their communities to reduce unscheduled admissions. DESIGN AND SETTING: A primary care cluster with areas of high deprivation, consisting of 11 general practices serving over 74,000 people. METHOD: A multi-disciplinary team with representatives from healthcare, local council and the third sector was formed to provide support for people with complex or social needs. A discharge liaison hub contacted patients following hospital discharge offering support, while cluster pharmacists led medicine reviews. Wellbeing Connectors were commissioned to act as a link to local wellbeing and social resources. Advance Care Planning was implemented to support personalised decision making. RESULTS: Unscheduled admissions in the over 75 age group decreased following the changes, equating to over 800 avoided monthly referrals to assessment units for the cluster. Over 2,500 patients have been reviewed by the MDT since its inception with referrals to social prescribing groups, physiotherapy and mental health teams; these patients are 20% less likely to contact their GP after their case is discussed. An improved sense of wellbeing was reported by 80% of patients supported by wellbeing connectors. Staff feel better able to meet patient needs and reported an increased joy in working. CONCLUSION: Improved integration between health, social care and third sector has led to a reduction in admissions, improved patient wellbeing and has improved job satisfaction amongst staff.

The ageing of the population: implications for multidisciplinary care in hospital.

BACKGROUND: Comprehensive geriatric assessment and multidisciplinary intervention are of proven benefit in the care of older people. OBJECTIVE: To determine whether patients' multidisciplinary needs in hospital can be met by current service provision. DESIGN: A comprehensive census assessing the multidisciplinary needs of an entire inpatient population compared to available multidisciplinary therapy time. SETTING: A large teaching hospital Trust, comprising six hospital sites. METHODS: On census day, the age, Barthel Index score and multidisciplinary needs of all adult inpatients were documented. Each therapist completed a questionnaire regarding their direct patient contact time on census day. RESULTS: 889 of 1,324 eligible patients (69%) had multidisciplinary needs on census day. These patients were scattered throughout all 46 acute wards, 14 rehabilitation and 4 continuing care settings. Mean age was 65.3 years in acute wards, 73.5 in rehabilitation wards and 80.8 in continuing care. Age correlated inversely with Barthel Index score (r -0.255, P <0.01). The percentage of patients with multidisciplinary need increased with increasing age. The calculated number of minutes of therapy time per day available to each patient varied between therapies and across sites. Mean physiotherapy time available per patient needing physiotherapy on census day ranged from 17 minutes 41 seconds in acute wards to 26 minutes 24 seconds in rehabilitation wards. CONCLUSIONS: A high proportion of inpatients, particularly older patients, across all care settings have multidisciplinary needs. This needs to be expressly considered in the planning of future health services if multidisciplinary needs of older people in hospital are to be met.

Setting up a multidisciplinary journal club in learning disability.

This article presents an account of how a journal club with a multidisciplinary membership from learning disability practice was set up. It presents a review of the literature which discusses the purpose, function and setting up of journal clubs. It outlines how topics were selected, the appraisal tool used to review articles and how findings from the reviews were disseminated to practice areas. The article in identifies the lack of research in the areas of learning disability practice. It demonstrates the positive aspects of working in collaboration with other members of the multidisciplinary team and how this provides opportunities for professional development. It identifies that support from management is essential in enabling staff to take time to attend and participate in the journal club.