60 seconds with...the RAFT (Rapid Access Frailty Team)
We spoke to Rachel Taylor and Luis Mieiro about the RAFT (Rapid Access Frailty Team).
What is the RAFT?
Luis
The Rapid Access Frailty Team was set up in March 2020 in response to the reduced numbers of patients in A&E.
Before the pandemic, Whipps Cross Hospital was seeing roughly 250 patients a month coming in as a result of falls. One month after the pandemic started, this number came down to around 100 a month. This meant that not all patients were getting better at home, but that they were not coming in to the hospital.
We felt what the frailty service needed was to complete the patient pathway from home, community, coming to the hospital, then going back home. The missing layer was reaching out into the community, partnering with our colleagues in primary care and community services, to provide integrated care for frail, older people.
So we decided for the acute frailty service to transfer the care, usually provided in the hospital, to the locations where the patients were experiencing severe symptoms of frailty – most often in their homes and care homes.
We felt that we had to do something that was meeting patient's needs in this area. We had to set up everything from scratch and there's no script for these things, providing frailty assessments, without the patient or GP referral needing to fill in any forms. It was a challenge but once we were set up, the rest of the path is about quality improvement, learning what's not working and doing things differently.
How did the team change their roles so quickly?
Rachel
It was very much a case of learning on the job. Our paperwork, our kit bags, everything has evolved a number of times so that we could try and optimise what we do. From the first day, our approach was "let's just go and see, and take it from there".
It was a really positive response from patients and their families. We're collecting some formal patient experience feedback, which our patient experience team are doing on our behalf so there will be an independent feedback process too. The patient experience team at Whipps Cross are currently doing retrospective interviews with patients and carers.
But I think it was very positive. We could quickly know what worked and what didn't work. Within a couple of days, we had learnt what we needed to tweak. The patients and their carers were who we learnt the most from. And every time a new team member has come along, they have brought a fresh perspective and new ideas.
Luis
We had a name change as well. We started as the Rapid Assessment Frailty Team, because that's what we thought we'd be doing. We were quickly assessing patients living with frailty at home. But in time we understood that as a service we are providing access – access to our partner service providers, access to frailty expertise, access to a bridge between primary care, secondary care and community care. So we now provide that connection, sometimes that means managing a community referral where a patient will benefit from coming into hospital.
How has RAFT changed patient pathways?
Rachel
We look at what's appropriate for each individual patient. We know the benefits if we can intervene early enough and prevent an inappropriate hospital admission. But when the right thing is to come to hospital, we can manage that admission in a very organised way.
Some people we need to bring in to hospital there and then, but often we can give them time, to prepare them for hospital admission and schedule the ambulance. The teams here at Whipps Cross are then expecting that person, and it can be a much better pathway for the individual patient and for their loved ones as well.
Luis
When a patient is in a crisis by themselves at home, and they call an ambulance that brings them to hospital, there is so much uncertainty and anxiety surrounding this. When RAFT sees a patient, we can explain the objectives of the hospital admission to the patient and their family, what are the current problems, and what's the expectation for this admission.
And this actually contributes to reduced length of stay, because these patients will have a senior review when they come to hospital and there's continuity of care. The team that brings the patient to the hospital is the same team that will then see the patient throughout their admission. This creates a bond between patient and carers; the patient sees the team as their personal point of contact in the system, linking them with the right services at the right time.