Julie Brown and Donna Wolstenholme on healthcare access for elderly and vulnerable patients

Acute Frailty Unit staff on improving quality of life for the vulnerable patients

Julie Brown is an Occupational Therapist and Donna Wolstenholme is a Physiotherapist. Both work in the Acute Frailty Unit at Lancashire Teaching Hospitals NHS Foundation Trust’s (opens in new window) Royal Preston Hospital, as well as the nearby Emergency Department. They talk here about the work of the unit, their passion for the job, and the opportunity the New Hospitals Programme offers to help the frailest people in our area to improve their health and live safely at home.

What is the Acute Frailty Unit and what kind of patients do you help?

The Acute Frailty Unit opened in August 2020 with temporary funding. It provides a service to help patients admitted through the Emergency Department whose health problem is connected to their frail condition. Many of these are patients aged over 75.

Typically, patients who benefit have been admitted through the Emergency Department because of a fall or as a result of an infection, and have been identified as being able to go home again with support after a short stay in hospital. During this time, our team will address ways to help their mobility, look into any factors that are causing them to struggle at home, and assess any issues such as confusion, which may be related to anything from dementia to the complication of multiple medications.

Many frail patients are struggling to manage and have repeated unplanned admissions to hospital when things go wrong. Our 10-bedded consultant-led unit operates for seven days each week, with input from a dedicated multidisciplinary team. Therapy staff and geriatrician consultants currently provide a five-day-a-week service. It tackles the underlying causes which led to an admission, ensuring measures are in place to minimise the chance of a repeat of the problems, helping patients and their families feel more confident about living safely at home.

What is the scale of the challenge you face now and in the future?

The numbers of acutely frail patients across our region are increasing year-on-year, due to our ageing population. This rising demand poses a significant challenge to the NHS and our colleagues in other parts of the hospital, leading to many unplanned admissions and creating a demand on beds.

Unless the needs of these patients can be identified and addressed quickly on, or even before, admission, there is a risk that they can spend a significant amount of time in hospital, being moved from ward to ward. This in turn has an impact on their overall wellbeing and the future ability of the patients to go home and resume an independent life.

Currently we have only a small service which means there is a limit to how many patients the Acute Frailty Unit can help. We are assessing the effectiveness of our relatively new unit but already we believe there is scope to expand our numbers and remove pressures on other parts of the hospital.

What results have you seen so far?

The figures so far indicate that the Acute Frailty Unit initiative is making a difference, helping the patients to get home and lead a happier, more independent life with fewer ongoing problems.

We believe the evidence is already making a strong case for expanding the service and maximising the input of therapists to address issues before they become more severe. This fits well with the ambitions of the New Hospitals Programme’s work to develop new ways to keep people well and at home and reduce overall admissions to hospital.

What opportunities does the New Hospitals Programme offer for you to do things differently?

The current environment of the unit is far from ideal, since it had to be created within the constraints of an old building. Currently, we lack the space to deliver as much therapy as the team would like, and there are also challenges in terms of the quality of facilities. A better ward environment would significantly improve the experience of patients and would contribute to our aim of getting people home as quickly as we can.

The hospital requires redesigning with the needs of patients in mind, particularly in terms of being more dementia friendly. For families, who often have to travel some distance, it needs to be more accessible and easier to find, with parking nearby.

We already work closely with our colleagues in the Community Frailty Team run by Lancashire and South Cumbria NHS Foundation Trust (opens in new window) and with the Rapid Assessment Team. However, it would be great if we all could have access to the same IT and information to allow us to work more seamlessly with community and social services. Their work is also vital in helping to keep people in their own homes.

We have the scope to use technology to roll out more virtual exercise classes and provide more services closer to patients’ homes. Therapists have an important role not just in immediate interventions, but in contributing to keeping the individual feeling well and supported and anticipating problems before they occur.

Ideally, the most benefits could be achieved by the creation of a clearly visible one-stop Frailty Hub for both acute services and the community, allowing patients and families, GPs and hospital colleagues to refer individuals who are struggling. In that way, interventions and home support, such as a Hospital at Home model, could be put in place to avoid many of the current admissions to the Emergency Department in the first place.