What is the Chesterfield Royal Hospital's Acute Frailty Ward?
The acute frailty ward, officially known as the Acute Frailty Unit (AFU) at Chesterfield Royal Hospital (CRH), is a dedicated service for older adults, typically aged 65 and over, who are experiencing an acute health crisis related to frailty. Instead of admitting these vulnerable patients to a general medical ward or leaving them in the busy Emergency Department (ED), the AFU offers a more tranquil, specialized environment for assessment and treatment. The unit's primary goal is to conduct a rapid and comprehensive geriatric assessment (CGA) and, where possible, facilitate same-day or short-stay discharge back into the community.
The Purpose of the Acute Frailty Unit
The fundamental purpose of the AFU is to provide swift, patient-centred care that directly addresses the complex needs of frail older people. This helps avoid the negative outcomes often associated with prolonged hospital stays, such as functional decline, cognitive issues, and increased risk of readmission. By streamlining the patient journey, the unit ensures that older individuals receive the right care in the right place, ultimately improving their overall health outcomes and quality of life. This approach is driven by the 'Home First' ethos, which prioritizes a patient's ability to return to their own home or a suitable community setting as soon as it is medically safe.
How does the Acute Frailty Ward operate at CRH?
To achieve its goals, the AFU at Chesterfield Royal Hospital has implemented several key operational innovations, including a specialized team and a dedicated assessment area.
The Frail Elderly Assessment Team (FEAT)
A critical component of the AFU is the Frail Elderly Assessment Team (FEAT). This multidisciplinary team proactively identifies and assesses frail patients early in their acute presentation. The team includes:
- Geriatricians
- Advanced Care Practitioners
- Registrars
- Physiotherapists
- Occupational Therapists
- Pharmacists
- Social Workers
FEAT assesses patients referred from the ED or directly from General Practitioners, and directs them to the AFU for a comprehensive geriatric assessment.
The Ambulatory Assessment Area (AAA)
For selected patients, an assessment can occur in the Ambulatory Assessment Area (AAA) within the AFU. This area is equipped with recliner chairs for patients who do not require a bed, allowing for rapid assessment and potential same-day discharge. This avoids the need for a full hospital bed and keeps patients in a less clinical setting during their evaluation.
Who is cared for on the acute frailty ward?
The AFU at Chesterfield Royal Hospital serves older patients presenting with a variety of conditions that are often linked to or exacerbated by their underlying frailty. These conditions can include:
- Unexplained falls
- Sudden confusion or delirium
- Unexplained dizziness or syncope (fainting)
- Urinary tract infections (UTIs) and other minor infections
- Exacerbations of chronic conditions like COPD or heart failure
- Dehydration and malnutrition
- Mobility issues and reduced functional ability
Patients are typically identified as suitable for the AFU based on their age (usually 65+) and the clinical judgement of the assessment team. The goal is always to treat the acute issue and support the patient's swift return to their baseline functionality.
Multidisciplinary team approach to care
The AFU operates on a collaborative, multidisciplinary team (MDT) basis to ensure all aspects of a patient's health and social care needs are addressed.
| Specialist Role | Contribution to Patient Care |
|---|---|
| Geriatrician | Provides expert medical oversight, diagnoses, and manages complex health issues specific to older adults. |
| Nurses | Offer direct patient care, monitor vital signs, administer medication, and provide support throughout the patient's stay. |
| Physiotherapists | Assess mobility, balance, and strength, and develop plans to help patients regain function and reduce fall risks. |
| Occupational Therapists | Evaluate a patient's ability to perform daily living activities and suggest adaptive equipment or techniques for safe independent living. |
| Social Workers | Facilitate discharge planning, assess community support needs, and coordinate with external agencies for a safe transition home. |
| Pharmacists | Conduct comprehensive medication reviews to manage polypharmacy and ensure safe and appropriate use of medications. |
This integrated approach is crucial for addressing the interconnected medical, social, and functional challenges faced by frail older individuals. Twice-daily MDT meetings are often held to review patient progress and coordinate discharge plans.
Discharge from the Acute Frailty Ward
The discharge process from the AFU is a key part of its function. The unit focuses on creating a seamless transition from the hospital back into the community, with the aim of preventing future readmissions. The discharge team and social workers work closely with the patient, their family, and community services to develop a personalized care plan. This may involve referring the patient to other services, such as community physiotherapy, adult social care, or virtual wards, where hospital-level care can be provided in the comfort of the patient's own home. The emphasis is on proactive planning and communication to ensure a safe and successful recovery journey beyond the hospital doors.
Conclusion
The acute frailty ward at Chesterfield hospital is a highly specialized and patient-focused unit designed to provide comprehensive, rapid care for older adults presenting with frailty. By utilizing a multidisciplinary team and dedicated assessment areas, the unit effectively assesses and treats patients, with the ultimate goal of facilitating a quick and safe discharge back into the community. This innovative model of care helps to improve patient outcomes, enhance the patient experience, and reduce the burden on acute hospital services, demonstrating a commitment to meeting the unique and complex needs of the frail elderly population in Derbyshire. The AFU's success highlights the importance of early comprehensive assessment and integrated care in modern geriatric medicine.
How does the acute frailty ward at Chesterfield Hospital differ from a standard general ward? [Comparison Table]
| Feature | Acute Frailty Ward (AFU) | General Medical Ward |
|---|---|---|
| Patient Focus | Specifically for older, frail patients with acute frailty-related issues. | Broad range of medical patients, regardless of age or frailty level. |
| Assessment | Rapid, comprehensive geriatric assessment (CGA) by a specialized MDT upon arrival. | Standard medical assessment, potentially with delayed specialist input. |
| Team Structure | Dedicated, co-located multidisciplinary team (Geriatrician, PT, OT, SW, Pharmacist). | Input from various specialists may be requested but are not always part of a cohesive, ward-based team. |
| Length of Stay | Aims for short stays, often less than 72 hours, with a focus on quick discharge. | Can involve longer hospital stays, particularly for older, complex patients. |
| Discharge Planning | Proactive, integrated discharge planning to community services from day one. | Often initiated later in the patient's hospital stay. |
| Environment | Designed to be quieter and more tranquil than a busy A&E or general ward. | High-traffic and often noisy environment, not optimized for frailty needs. |
