Acute Care Assessment

Original Editor - Natalie Patterson Top Contributors - Natalie Patterson, Jeremy Bryan, Vidya Acharya and Justin Bryan

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (28/09/2020)

Introduction

Acute Medical Unit (AMU) is an area of the hospital where acute illness can be assessed and initially medically managed, they are often located near to the emergency department.

Both PTs and Occupational Therapists (OTs) are core members of the AMU MDT helping to make rapid risk assessments and plans to support early discharge. The aim of therapists in the AMU is to make early plans for discharge and set goals to reduce length of stay in hospital as well as, establishing transfer methods and encouraging early mobilisation during an admission.

Background information

England

In England from the 21st of August 2020 all NHS hospitals are working towards a new Discharge to Assess Model (D2A). For those admitted to an acute hospital, 95% are expected to be discharged home as default. The Discharge to Assess Model sets out 4 pathways:

• 50% of people are expected to be discharged home with the same level of support on admission or with voluntary and community support, Pathway 0.
• 45% of people are expected to be discharged home with up to six weeks recovery support from health and social care services, to maximise their independence and stay home for longer, Pathway 1.
• 4% of people are expected to be discharged to bedded rehabilitation settings to support their return home, Pathway 2.
• 1% of people are expected to be discharged into long-term care settings, such as a care home, Pathway 3.

The aim of the new D2A process is to begin discharge planning from the point of hospital admission where appropriate, including the identification of immediate needs of the individual at home following discharge. Information about the home circumstances for people should be collected at the point of admission. If further home assessment is required this should be undertaken in good time, coordinated between health and social care and should include equipment and reablement support.

Funding

Additional care (more than needed on admission) and support needs for all individuals on discharge from hospital (where required) will be provided free of charge for up to six weeks to allow for post- discharge recovery and support services, and any assessments of ongoing care needs and financial eligibility determinations to be made.

The role of an Acute Therapists

Acute Therapist are considered Physiotherapists, Occupational Therapists and Therapy Practitioners and Assistants

• A significant part of the role will be in non-acute settings (mainly in people’s homes)
• Complete limited assessments for discharge during admission.
• Telephone the following day after discharge to check and offer reassurance/advice.

Roles may include:

• Taking on the case management role and undertake the first assessment at home of a person.
• Acute therapists will assess people in their own home/usual place of residence at the request of the single coordinator and agree a recovery and support plan with the person including reablement support and/or equipment.
• This will be a trusted assessment which will be accepted by the receiving care provider (agreement as to universal document to be used across acute and community services).
• Working much more fluidly between community settings, people’s homes and within the acute trust, depending on the capacity demands.
• A 7 day service will be required to achieve the D2A's goals.

Acute Assessment

Subjective Assessment:

1. History of present condition
2. Past medical assessment
3. Social History:

Objective Assessment:

Outcome measures: Barthel Index, Elderly Mobility Scale, Tinetti, Functional Independence Measure, Berg Balance, 10m walk test,

Gait analysis

Functional Assessment:

• Assess transfers as they would at home
• Review mobility with appropriate aids if required e.g. stairs assessments, step assessments
• Determine if able to complete personal care and dressing independently

Respiratory assessment if required

Analysis:

Problem List

Patient Goals

Plan:

Resources

• NICE; Transition between inpatient hospital settings and community or care home settings for adults with social care needs
• QUICK GUIDE: DISCHARGE TO ASSESS
• Why not home? Why not Today?