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New 'Frail patient' team aims to ease congestion in A&E.

Byline: Mark Smith Health Correspondent

ANEW service which assesses frail patients at the front door of A&E has been launched, in a bid to free up hospital beds and reduce waiting times.

The Frail Patient Assessment Team at Swansea's Morriston Hospital, which includes specialist doctors and therapists, aims to ease congestion in its emergency unit, which consistently has the lengthiest waiting times in Wales.

Older people represent a relatively small proportion of patients attending the emergency department but account for seven out of 10 hospital admissions.

Abertawe Bro Morgannwg University Health Board claims many of these frail patients are in hospital longer than they should be - or didn't really need to be admitted in the first place.

While the old adage is that hospital is "the best place" for treatment, in truth hospital admissions carry risks, such as potential infections or loss of independence.

So the new team assesses these patients as soon as they come into A&E so doctors can decide early on whether to admit them or not.

A total of 70% who have used the service since its launch in October are over the age of 81, but a small number have been as young as in their 50s.

Patients who fall, are confused, have poor mobility, live in a nursing or residential home or who already have a care package will be eligible.

The new team comprises care of the elderly physicians Nicholas Coles, Elizabeth Davies and Brett Maddock, working alongside occupational therapists, physiotherapists and bed managers.

Dr Coles explained: "Not every elderly patient is frail. There are patients in their 90s who regularly walk their dog, for example, are generally well, and may have just have one thing wrong with them.

"These are not the patients we are focusing on.

"We assess patients who are frail - whatever their age - as soon as possible, and offer them consistent care, with a clear treatment plan and quicker access to the right services which meet their individual needs."

Abertawe Bro Morgannwg was the worst-performing health board in Wales in December for A&E figures, with a quarter (27%) of patients in the unit for more than four hours.

And Morriston Hospital was the biggest contributor to the poor total, with four in 10 (41.3%) experiencing such delays.

But it is hoped the new service will slowly help to improve the figures.

As part of the service, physicians will spend their mornings assessing frail patients on the wards and in the emergency department awaiting possible admission.

They meet with therapists as part of a multi-disciplinary team to work out the best individual treatment plans.

With almost a third of the frail patients in their 70s or younger, the new service helps patients who would have been missed by traditional frail elderly services, which concentrate on the over-80s.

Dr Coles said: "Sometimes relatives or carers worry if a patient isn't admitted, because they believe hospital is the best place for them.

"If they really need hospital treatment, then that is the case.

"But often patients don't actually need to come into hospital to get the care they need.

"Being in hospital does carry risks, for example, frail patients are at risk of getting a health care-associated infection, or DVTs (blood clots).

"Or they may begin to lose their independence if they are away from home and their daily routine.

"Even risking a fall on a hard hospital floor rather than a soft carpeted one at home needs to be considered.

"Working in this multidisciplinary way we can assess patients much earlier on and offer better and faster access to tests and treatment.

"In many cases patients either don't now need to come into hospital to access this care, or if they have been admitted, we can help them go home on time."

The team now hope to add a clinical nurse specialist before long, and also work more closely with social services colleagues to make it easier for patients to go home with care packages in place.


<BElderly care physicians Nicholas Coles and Elizabeth Davies - members of the new Frail Patient Assessment Team
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Publication:Western Mail (Cardiff, Wales)
Geographic Code:4EUUK
Date:Jan 25, 2016
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