A clinically-led pilot scheme for pre-transfer clinical discussion and assessment (PTCDA) was introduced on 31 March 2020, bringing together system partners from across primary care, community care, secondary care, ambulance service and social care personnel, all working together in new ways to promote both an effective community response and to avoid assessment duplication.
The pandemic meant the pilot was accelerated and priority was given to the patient-facing functions of the PTCDA. This would often entail a swift clinical discussion with a consultant geriatrician or geriatric emergency medicine consultant for supportive decision-making around hospital admission and exploring safer alternatives that might entail community-led work with other partners.
The provision of enhanced community assessment bundles as an alternative to hospital admission was often the preferred option for patients and their families. In any complex situations warranting a rapid response, the patient would receive a follow-up visit from a geriatrician, with a special interest in care home medicine, rather than waiting a longer time for the patient’s usual GP to follow up.
Patients who did end up being admitted received active case management, which facilitated rapid access to supportive treatments and reduced their length of stay. Enhanced assessment bundles would apply once they returned to the community, with structured feedback to the usual GP practice.
In conjunction with the LLR CCGs and the research and education team from local hospice charity LOROS, clinicians engaged in training and development sessions with care home staff, paramedics and GPs through virtual seminars and rapid CPD interventions during case discussions. These provided valuable system-wide learning and insights into the challenges facing other teams. Best practice continues to be shared to improve the ways in which the model is working.
The PTCDA pilot can now be accessed by any community-based clinician who is considering admitting a patient with significant frailty/complex comorbidity, whether from a care home or their own home. This includes East Midlands Ambulance Service (EMAS) paramedics and technicians, general practitioners and other practice-based clinicians, and Derbyshire Health United (DHU) out-of-hours professionals.
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