In this podcast Richard Biram, consultant geriatrician at CUH, and Dr Helen Watson, Director of AHPs at CUH, give an insight into AHPs and the important role they play in patient recovery at our hospital.
Richard
I've worked here in the department of medicine for the elderly for the last 14 years, there are two main areas where I work very closely with the allied health professionals (AHPs) in the hospital.
Richard Biram
“Firstly, it's on the medicine for the elderly ward which is a standard medical ward but which is filled really with a group of very frail, older adults with a variety of different problems, often, problems such as difficulties walking, and difficulties eating and drinking, difficulties with home circumstances so needing a lot of discussions about the home situation, plans for discharge once the medical side of things has been sorted out.
“On a daily basis we will meet with AHPs in our in our morning ward meeting there'll be a physiotherapist and an occupational therapist at a minimum, as well as the ward nursing staff and the other doctors on the team and so on, and we'll have quite detailed discussions about the progress in terms of medical care but also in terms of the general overall health of the patient.
“That will include things like a functional assessment it might include an assessment of the capabilities undertaking activities of daily living and it might indicate also include things like indications of whether or not a patient is going to need some extra assistance at home.
“Those discussions with members of the AHP teams, such as occupational physiotherapy in particular, are very helpful in bringing that information back to me because I can't go and get all of that information myself, I don't have the expertise to undertake a lot of those assessments.
“Like an assessment of a patient, whether they can manage a meal, whether they can climb a flight of stairs all of these sorts of things, so that feedback from the AHPs is absolutely vital in helping me to come up with a plan for discharge. It helps us to work as a team, to come up with an idea of where discharge might best be. Some patients for example might end up in somewhere like an ongoing rehab facility, such as one of our community hospitals, and we need to know what the AHPs think.
Is there is going to be a therapeutic benefit from that kind of placement? I can't come to that conclusion myself, it's very much a team effort.
Richard Biram
“I've just come from a meeting with a patient's relative, dietitian and a speech and language therapist. We were undertaking quite a complex review of someone's swallowing ability, their overall nutritional capability and I was able to have quite a detailed discussion with the relative of this patient who's having difficulties with their nutrition.
“I wouldn't have been able to undertake this by myself but by utilizing the whole team we're able to come up with a good plan of action and the AHPs will have a lot more idea of what is available, whether that be what nutritional supplements are available, what ideas there might be for the best consistencies of food that the patient should be able to eat.
“If it's an occupational therapy review, what aids might be available for somebody? All of that input is absolutely vital for the patients that I work with, it isn't just about the medicine it's about everything else that's required to get someone functioning to their best ability and getting them home as safely as possible.
Helen
“Like you say it is about the team working together isn't it and everybody having their own specialism and contributing to making a decision about somebody's care and somebody's forward treatment.
“That is based on all of those different aspects like you say, you've got your skills but actually you haven't got all of those skills and when they're all pulled together by different members of the team that's what makes true multidisciplinary care.
Richard
“It is and it really comes to the fore in the other part of my work in our surgical pre-assessment clinic, again for frailer patients, and this is a multi-disciplinary clinic which is very different in style in that it's a geriatrician and an anaesthetist working in the same clinic room as an occupational therapist and a physiotherapist.
“In that situation I actually get the opportunity to see those assessments being undertaken which is very interesting from my point of view because, I get the feedback from those assessments on the ward sometimes but, in the clinic, I actually watch the therapists as they undertake their physical assessments.
When I'm discussing things with patients, the information which is being brought to us by the therapy teams is absolutely invaluable in making sure we come up with a solid plan for a patient's care from start to finish.
Richard Biram
Helen
“I've been in the clinic and that's a great example, and it's also a great example of where the occupational therapist and the physio actually work really closely together. They almost dovetail their roles and they can actually fill in for each other, that is a true multidisciplinary approach but also an interdisciplinary approach to working, which works brilliantly for the patients. I've sat in a couple of times and been really impressed.
“I'd be interested in your thoughts on the proactive nature of that clinic as well in terms of talking to patients about what to anticipate post operatively.
“That's something that I think, from a rehabilitation, physio and occupational therapy point of view, is really important. To give the patients a bit of insight, knowledge and information about what to expect.
Richard
“It's even more than that because it starts before the operation, so when we have a run-up into surgery, we have an active process of pre-habilitation.
“Trying to pre-empt and strengthen patients and get them ready for their surgery. That might involve special breathing exercises, it might involve discussions about what exercises patients can do to build themselves up or particular nutritional supplements to use.
There's also that discussion, which you alluded to in the clinic itself, where we get an opportunity to talk to patients and their relatives about what to expect after a hip replacement or after a knee replacement.
How long are they likely to be in hospital? What's the recovery going to feel like? I can have some of that discussion from my experience but I don't work in orthopedics every day, I don't work on all of the different surgical wards whereas the therapists of course have dealt with and looked after patients in this situation.
Richard Biram
“Their expertise in recovering someone from a knee replacement is much greater than mine, I can help make the plan for getting through surgery and discuss some of the medical implications.
“But what it's going to feel like, and how it's going to be after the operation, whether they're going to need help at home, for this sort of thing an AHPs experience is invaluable.
Helen
“I'd be interested to ask you a final question just about the future. Our teams, occupational therapy and physiotherapy in particular, are doing a lot of work with discharge to assess pathways and trying to work closer with community colleagues to work on the patient's journey from hospital on to the next place to be as smooth as possible.
“I'd be interested in your thoughts on the role of the therapist in that discharge to assess and how you think in the future where that might be going?
Richard
“Well, that's a big question isn't it!
“I've been out with one of the community teams, which is made up of therapists and nursing staff some of whom have worked with us on the ward.
“In my role as a geriatrician, I've worked previously in community hospitals and various other rehabilitation type facilities, so the therapist will have exactly the same role that they've always had.
“In terms of helping the multi-disciplinary team to come up with appropriate plans for discharge, one of the difficulties we have as clinicians is being able to have those discussions across the boundary between secondary and primary care and a lot of the most useful input that we have in this situation is where, for example, the physiotherapist on the ward will actually make that phone call and contact the primary care service or the community based service and we'll have a discussion about how things have been progressing, what sort of things can be offered and have that clinical hand over.
“The clinicians really wouldn't be undertaking that, it's something which I think the therapists have a much better understanding of and much better links with the community teams.
I guess we're going to hopefully see a blurring of lines between these two services, particularly with the onus on trying to get patients home, but then you need to have those services available at the home to be able to provide that ongoing support.
Richard Biram
“That's something I think we need to see a lot more of in the future, particularly as a lot of the longer stay facilities have shrunk.
“I've worked very closely with AHPs and have done throughout my career; I've done many years now in wards specifically for older adults and working with AHPs is an absolutely vital part of my work.
“We very much think of ourselves as being a multidisciplinary profession, what I would recommend to anyone is look at what the AHPs are writing in the notes.
“Listen to your AHPs because the number of times I've been pulled out of the fire by an AHP telling me they're worried about someone's leg or hip; they're walking them around and we find something unexpected that the medical team have not identified.
“I think this um is an absolutely vital aspect of working with older adults in particular, to listen carefully to your AHPs and if they're worried about something take it very seriously.