AimTo create a service ensuring patients are assessed swiftly, receiving the right treatment, in the right place at the right time ultimately improving patient flow.

Urgent referrals for geriatric acute assessment in Aberdeen inevitably led to admission. Patients’ stayed longer than necessary resulting in uncertain discharge dates, treatment plan delays and ward transfer delays.

Methodology• A 2008 pilot gauged whether assessment

could be ‘streamlined’ to prevent crisis admission and improve patient flow.

• Evaluation suggested that admission was avoided for 65% of 80 patients who attended a Rapid Assessment Clinic within 36 hours of referral. One limitation was that the service was only available 9am - 5pm, Monday - Friday. To maximise the impact, 24/7 access was needed.

• The Triage Unit model was developed and opened in July 2009. This allows all urgent referrals to the geriatric service at Woodend

Hospital to be assessed and commence treatment in the Triage Unit. Thereafter some patients can return home within 24 hours of arrival, patients who require a longer stay can be referred onto the most appropriate ward. Prompt assessment by a multi-professional team led by a Consultant Geriatrician enables rapid development and implementation of treatment plans which may be carried out, when appropriate, by the wider community health and social care team.

Results• After four months the Unit received 756

referrals. Of those triaged, 10% didn’t require admission and were seen, treated and returned home direct from the Unit. Of these, half were discharged within 24 hours. The average turn around rate is now sustained as 15%.

• Service more streamlined. Length of stay reduced from 21 days to 11 days.

Caring • Listening • Improving

Improving patient flowby streamlining urgent geriatric referrals

for assessment and treatment

Impact on the length of stay for patients referred through the Triage Unit at Woodend Hospital

By Lauren Tweedley, PFPI Officer, Corporate Communications. Designed by NHS Grampian Corporate Graphic Design.

Staff experienceStaff also feel that this way of working

is making a difference.

Patient experiencePatient experience interviews took place between June 2010 - February 2011. Some of the patients feedback included:

“I was told I was going to the Triage Unit where they will investigate

everything instead of focussing on one problem”

“It was the right place for me”

“It was the best place for investigations”

“I felt I got better quicker due to initial assessment which led to the right

treatment being started right away. Instead of sitting about in a ward for ages, the assessment and tests were carried out straight away – this is a

really good idea. Because of this, I feel a lot of my problems have been sorted and I am managing much better with

every day tasks”

“We want people who come to the Triage Unit to feel they are getting a thorough

assessment of their health and care needs. The team can access appropriate hospital and

community services and can utilise these to the benefit of the individual.”

Susan Webster Senior Charge Nurse

Conclusion• Early multi-professional assessment and senior

decision making can make the difference between a lengthy hospital stay and a rapid discharge home for at least 15% of patients referred from primary care.

• Length of stay can be improved dramatically by early, senior and multi-professional assessment and treatment.

• Community based multi-disciplinary teams treating patients in their own home can maintain hospital flow for more acutely ill patients.

• Patients, relatives and staff have responded positively to the improved patient pathway resulting from the creation of the Triage Unit.