In May 2015 we set up the Acute Assessment Unit (AAU) on Swift ward, Kingfisher Court. This the new £40 million inpatient unit that was opened in 2014 in Hertfordshire.
The old AAU was based in 2 different units and only accepted patients for 72 hours.
The old model was not working which led to the changes being proposed and implemented. The Acute Assessment Unit accepts referrals from all over Hertfordshire. It is an 18 bedded mixed sex ward, with all patients having their own ensuite room.
From start: No
During process: Yes
In evaluation: No
PP Collaborative: Yes
Find out more
Dr Joanne Farrow - Medical Lead and Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust (HPFT)
In May 2015 we set up the Acute Assessment Unit (AAU) on Swift ward, Kingfisher Court. This the new £40 million inpatient unit that was opened in 2014 in Hertfordshire. The old AAU was based in 2 different units and only accepted patients for 72 hours. The old model was not working which led to the changes being proposed and implemented. The Acute Assessment Unit accepts referrals from all over Hertfordshire. It is an 18 bedded mixed sex ward, with all patients having their own ensuite room.
The staffing on the ward was increased and now there is a large team of nurses, Crisis Team nurses, doctors, psychologists, OTs and pharmacists that work on the ward. • All patients that are admitted are seen by a doctor and then have a MDT review led by a consultant within 24 hours. There is a weekend rota of consultants to ensure the care provided is the same at the weekends. • The increased staffing allows the patients to have a through physical examination, and to have any medical problems investigated. • There is also access to an onsite housing worker, drug and alcohol worker and an onsite police officer. • The AAU keeps patients for up to 10 days to carry out a thorough assessment and to start treatment. If patients needs to stay in hospital for longer than 10 days they move to the treatment ward which is nearest their home. • We invite families, carers and the care co-ordinator in to the ward for meetings. Ward rounds and meetings happen every day with 2 full-time consultants on the ward ensuring all patients have intense assessment and treatment as needed • Around 50% of patients are discharged from the AAU to go home with support of the Crisis Team, to go to the Day Hospital, to go to a Host family, to the care of the community team or back to the care of the GP- whatever care is appropriate. • The big impact of the AAU is that the trust is now much more able to effectively manage its beds. Last year there were around 20 patients in non-HPFT beds which sometimes were far from home. • We now rarely have to admit someone to a non-HPFT bed and have had many days and weekends when he have had a green bed status meaning we have a number of beds available for admission. • This allows us to provide much improved care for our patients, close to home and to allow their teams to be involved. • This also allows better use of the trusts financial resources so money can be spent on developing and improving our services rather than paying for non-NHS beds.
Wider Active Support
We work with partners such as Spectrum and Housing to ensure that all patients have access to this service on the ward. The workers come onto the ward and carry out assessments and give people the support they need to allow them to be discharged and to prevent delays in discharge.
Our partners are our two CCGs in Herts, the 2 acute trusts, the GPs in Herts, Spectrum (drug and alcohol services), Herts Young Homeless.
All our partners value Herts patients being treated in local service rather than going to non-HPFT beds.
We carried out a review of the service after 3 months.
We sent out questionnaires to all staff involved in the AAU to get feedback and made changes based on the results.
We changed the timing of discharge meetings, we made the morning review meeting more focused and effective, we agreed that nursing staff numbers should be increased.
We seek feedback from all carers and service users who use the service. We have made changes including improving the ward information booklet, we have put signs and notices up so service users know the timetable of the ward and the amount of OT and psychology input has increased.
Looking Back/Challenges Faced
The planning of AAU moving to Swift took around 1 year and it was delayed on a number of occasions. It took a long time for agreement to be reached on changing the AAU model from 3 to 10 days.
The extent of the workforce problems that have been generated by locating all of the AAU beds on a single ward was not anticipated. This has been evident in all disciplines including medical, nursing and pharmacy. There should have been a more robust preliminary assessment of the increased demands on staff and guidance should have been sought from the Human Resources Team during the planning process.
The AAU was moved to Swift ward despite concerns being raised in advance about the ability and willingness of some of the existing Swift ward staff to adapt to significant changes involved to working practices on the AAU. It would have been preferable if the planning process could have involved early assessment and identification of competency and motivational issues amongst existing Swift so that these could have been addressed at a much earlier stage with the staff involved.
The roles of all of the AAU staff: nursing staff, OTs, psychologists, pharmacists, admin staff and medical staff should have been specified in detail and the skills and aptitude of the staff should have been assessed against these requirements. Challenges Faced and how they have been overcome: • The AAU has been very busy and at times staff have been under great pressure. • The team has worked very hard and very well together. • The increase in staff numbers have helped address some of the challenges. • The medical staff are always available to help and support the nursing staff. • The Crisis Team staff carry out many tasks on the ward to ensure that good assessments are completed and they also liaise with families and care coordinators to arrange meetings. • To build the team a number of evenings out have been arranged and an away day was held. A party to celebrate one year of the AAU has been planned to thank staff for their hard work.
There has been an agreed increase in the funding for the necessary increase in ward nurse staffing, there has also been an increase in ward admin staff and medical secretaries to support the staff.
The student nurses that have worked on the ward have had a very positive experience and many of them have expressed a desire to work on the ward. Another full-time consultant has been appointed to the ward.
Evaluation (Peer or Academic)
An evaluation was carried out after three months to assess if the service provided was safe and effective. This showed that the ward was both safe and effective. • More patients have been discharged within 72 hours than under the previous model. • The length of stay appears to be decreasing, despite more detained patients being admitted • Overall patient flow has improved and this has been associated with more availability of treatment beds and significantly less out of area bed usage. • More patients are admitted during working hours • Swift ward appears to be safe based on the number of SIs and complaints.
Measures to improve patient safety that have been put in place include: • 7 day consultant reviews with CATT so that all patients are seen by a senior doctor within 24 hours of admission (started mid-August 2015) • More involvement of ward nurses in patient reviews • Increased junior doctor cover has resulted in improved physical health assessments with all patients being offered a full baseline examination within 24 hours • Dedicated medical secretarial time which ensures discharge summaries and notifications are sent and information sought from GPs at the outset of the admission • Positive feedback was received from patients and families
An evaluation report was written and shared with staff across the trust.
A trust-wide showcase was held and staff from across the trust were invited and attended, and all the team presented their work. The work was presented to the board. It is also planned that the work is presented to a public board meeting.
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