scholarly journals 48 Specialist Physiotherapist Leading in the Frailty Revolution in Ambulatory Emergency Care at the John Radcliffe Hospital, Oxford

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
B Greensitt
Keyword(s):  
Support Services ◽  
Community Support ◽  
Training Programme ◽  
Community Services ◽  
Ambulatory Setting ◽  
Admission Rates ◽  
John Radcliffe Hospital ◽  
Bed Days ◽  
The Impact ◽  
Therapy Intervention

Abstract Background The Ambulatory Assessment Unit (AAU) at the John Radcliffe Hospital aims to provide excellent care for complex patients with varying range of medical presentations. It sees over 50% of the acute take in operational hours, with over 40% of AAU patients over the age of 70. Staff feedback consistently identified a suboptimal service provided to the frail group within this patient cohort. A dedicated physiotherapist specialising in older people living with frailty joined the team in October 2018 to address this. Aims Early identification of patients with frailty attending the unit Improve staff understanding of frailty to enhance patient care Assess patients to either enable a patient to return home safely or support ambulatory pathway Refer to community services that can support the patient and enable them to live well after hospital attendance Review the impact of the specialist physiotherapist’s role Methods Introduction of frailty identification as per frailty team guidance Frailty questionnaire to ascertain baseline understanding and learning needs to develop staff training Assess patients using a Comprehensive Geriatric Assessment Raise staff and patient awareness of community support services available within the community Data collection to review interventions taken, bed days saved and re-attendance rates Results 129 new patients were seen in a 4-month period. 85% returned home the same day; 64% had their ambulatory pathway supported with therapy intervention and 21% had an acute admission avoided directly due to therapy. 15% were admitted to an acute bed for safety 60% of patients were referred to community services and 50% were signposted to a range of community and support services The re-admission rates for therapy related reasons within 7 days and 30 days were 0% and 4% respectively. 38 bed days were saved with a calculated cost saving of £15,162 Future service delivery and conclusions There is ongoing work to obtain patient experience data for those who had their admission avoided directly due to therapy intervention. A training programme on frailty for all members of the MDT is to be developed. A dedicated therapy service in an ambulatory setting has a role in ensuring that patients’ needs are met in the most appropriate place and enhances their quality of life after hospital attendance.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Services communautaires et qualité de la vie: une étude d'impact en région éloignée*

1992 ◽  
Vol 37 (8) ◽  
pp. 553-563 ◽  
Author(s):  
Céline Mercier ◽  
Raymond Tempier ◽  
Et Claude Renaud
Keyword(s):  
Quality Of Life ◽  
Support Services ◽  
Satisfaction With Life ◽  
Group Living ◽  
Community Support ◽  
Remote Area ◽  
Subjective Perception ◽  
Community Support Services ◽  
The Impact

This longitudinal study with a matched comparison group was conducted in Abitibi, an area in North-West Quebec. Its goal was to observe the impact of community support services on the quality of life of long term psychiatric patients living in a remote area. A cohort of 47 subjects, living in a small town with a comprehensive network of community support services, was compared with a similar group living in a neighbouring city with only outpatient services. The satisfaction with life domains scale developed by Andrews and Withey and adapted by Baker and Intagliata was used at four times during the study. According to the results, the subjective perception of the quality of life in the two groups is comparable, even though the objective conditions are less favorable for the group participating in the community support program. The highest ratings were given to the place of residence, the neighborhood and its commodities; the lowest ratings were given to their love life and financial situation. One can observe a stability of the measures of quality of life over time and for the two groups. The perceptions of the sample living in a remote area are much more favorable than the ones of a comparable group living in the Montreal area. These results are discussed in a double perspective: the role of community support services in the daily life of people who are having severe and persistant problems of mental health, and the interest of measures of quality of life.

A Follow-Up Study on some Schizophrenic Patients

1965 ◽  
Vol 111 (476) ◽  
pp. 617-624 ◽  
Author(s):  
J. T. Leyberg
Keyword(s):  
Large Degree ◽  
Research Unit ◽  
Community Services ◽  
Chronic Patients ◽  
Admission Rates ◽  
The Social ◽  
Schizophrenic Patients ◽  
Effective Community ◽  
The Impact

What happens to schizophrenics after their discharge to the community has been a subject of several recent studies. Most of this work is from the Social Psychiatry Research Unit at the Maudsley Hospital and deals with prospects of rehabilitation and resettlement, morbidity in the community, and the impact which these patients have on their families. Earlier follow-up studies of chronic patients who left certain London hospitals between 1949 and 1956 point to a satisfactory resettlement in two-thirds of cases (Brown et al., 1958). In more recent papers rather cautious conclusions were drawn, especially where morbidity in the community and not just lengths of hospital stay and re-admission rates were ascertained (Wing, 1963; Wing et al., 1964). Whilst the time spent in hospital by schizophrenics is now much shorter, re-admission rates continue to rise, and according to Wing “… in the absence of effective community services the policy of early discharges is based to a large degree on the willingness of relatives to attempt the role of nurse and put up with considerable discomfort and distress”. Furthermore, with existing services so different in various parts of the country, no reliable data exist which would indicate to what extent a fully developed community service could prevent morbidity of discharged schizophrenics. What is needed, according to Wing, would be a combination of the Nottingham community services, the Worthing day-centre and industrial workshops on the Bristol pattern.

A Consideration of Love Labour in Informal Caring: Family Caring in Ireland

2010 ◽  
Vol 18 (1) ◽  
pp. 82-99
Author(s):  
Jacqui O'Riordan ◽  
Féilim O'Hadhmaill ◽  
Helen Duggan
Keyword(s):  
Support Services ◽  
Extended Family ◽  
Family Members ◽  
Community Support ◽  
Community Services ◽  
Family Carers ◽  
Theoretical Perspectives ◽  
Community Support Services ◽  
Close Relatives

This paper is drawn from research on family carers1 that was carried out in the Cork area of Ireland in 2007–08. The research itself focused on the experiences of family carers and their access to support services in the locality. Key findings indicate that individuals are often caring for family members over the long term, often with minimal access to discretionary community support services. The assumption made by the Irish State, by community services, by carers themselves and by extended family members and friends, is that the onus is and should be on close relatives, and particularly women, to take the major responsibility for caring, when this care takes place in the home (Timonen and McMenamin 2002). This also contributes to the invisibility and undervaluation of family carers (Baker et al. 2004; Lynch 2007). The development of theoretical perspectives on caring can contribute to highlighting the manner in which assumptions about family, domesticity, gender roles and household continue to disadvantage those located primarily within the private sphere.

Is use of formal community services by older women related to changes in their informal care arrangements?

2012 ◽  
Vol 34 (2) ◽  
pp. 310-329 ◽  
Author(s):  
SAMANTHA J. MCKENZIE ◽  
JAYNE C. LUCKE ◽  
RICHARD L. HOCKEY ◽  
ANNETTE J. DOBSON ◽  
LEIGH R. TOOTH
Keyword(s):  
Older Women ◽  
Support Services ◽  
Service Use ◽  
Community Support ◽  
Community Health Services ◽  
Community Services ◽  
Sleep Difficulty ◽  
Complete Representation ◽  
Formal Service ◽  
The Relationship

ABSTRACTThis paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.

Some Reflections on Reparation in Post-Apartheid South Africa, using a Couple Therapy Intervention as a Microcosm of South African Society

2011 ◽  
Vol 1 (2) ◽  
Author(s):  
Andrea Hill ◽  
Sylvia Poss
Keyword(s):  
South Africa ◽  
South African ◽  
Couple Therapy ◽  
South African Society ◽  
Depressive Position ◽  
Central Hypothesis ◽  
Transference And Countertransference ◽  
Constructive Engagement ◽  
The Impact ◽  
Therapy Intervention

The paper addresses the question of reparation in post-apartheid South Africa. The central hypothesis of the paper is that in South Africa current traumas or losses, such as the 2008 xenophobic attacks, may activate a ‘shared unconscious phantasy’ of irreparable damage inflicted by apartheid on the collective psyche of the South African nation which could block constructive engagement and healing. A brief couple therapy intervention by a white therapist with a black couple is used as a ‘microcosm’ to explore this question. The impact of an extreme current loss, when earlier losses have been sustained, is explored. Additionally, the impact of racial difference on the transference and countertransference between the therapist and the couple is explored to illustrate factors complicating the productive grieving and working through of the depressive position towards reparation.

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