Acute Care Assessment

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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 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 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 have been 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. Trusted assessment arrangements should be used.

Additional care 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.

• At least twice daily review of all people in acute beds to agree who is not required to be in hospital and can therefore be discharged.

• Telephone the following day after discharge to check and offer reassurance/advice.

The role of an Acute Therapists (usually consists of 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.
• Roles could include (this is not an exhaustive list and will depend on individual skillsets):
• A single coordinator role will direct (for each person) who will take on the case management role and undertake the first assessment at home.
• 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).
• When and where will I do my work?
• You will work much more fluidly between community settings, people’s homes and within the acute trust, depending on the capacity demands and learning from the COVID-19 Level 4 emergency.
• Cover will continue to be required over 7 days so you may find your hours of work are adjusted.

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