The impact of a Consultant and Advanced Practitioner rapid assessment and triage (RAT) for acute GP Frailty admissions

Introduction 

Nationally frailty take numbers are increasing leading to unacceptable ED trolley waits for frailty IP beds, increased corridor care and ambulance handover times. In Southmead the GP Frailty take especially has increased exponentially in the past 2 years,  with referral numbers up by 50%. To address this problem the front door team are trialling an alternative way of working to improve efficiency.  

Method 

We had a frailty advanced practitioner tasked to be responsible for GP admissions to our acute frailty unit alongside a dedicated consultant geriatrician. They implemented a RAT process for the GP admits, which involved taking handover from paramedics and immediate patient assessment on arrival to the ward. The aim being that early senior decision making would improve efficiency, reduce repetition, reduce unnecessary tests and achieve more same day discharges and reduced length of stay. The advanced practitioner had oversight of the take and followed up patients the following day where suitable to achieve earlier discharge. 

Results 

The pilot is ongoing but results to date have been encouraging showing an increase in same day discharge rate to 24% from around 5%, day 1 discharges up from 9% to 17 %, and day 2 and 3 discharges both up from around 20% to 30%. Staff and patient feedback is positive with 100% of patients recommending the service to friends and family, and staff finding this way of working rewarding and efficient. 

Conclusion 

It is clear that this AP oversight/Consultant RAT process is an effective way to help manage increasing demand, through not only achieving more same day discharges, but also increased day 1, 2 and 3 discharge rates. This will improve flow helping reduce corridor care, and ED and ambulance waits for frailty beds.