Dundee Enhanced Care At Home Team

Dundee Enhanced Care At Home Team is a subspecialty of Medicine for the Elderly (Dundee).

Subspecialty Description

Who are we? We are a team of Cluster aligned Nurses, Advanced Nurse Practitioners (ANPs) Clinical Nurse Specialists (CNS), and Consultant Geriatricians.

Who do we see? Elderly patients who have had a noticeable increase in frailty or reduced functioning, acute illness, exacerbation of long-term condition and/or those at risk of further deterioration and admission to inpatient frailty units. We also provide enhanced nursing support to patients on discharge where there is no significant ongoing DN involvement.

What do we do? We provide a time-limited, targeted assessment and support to vulnerable elderly people during an acute episode of illness or deterioration. We conduct a Comprehensive Geriatric Assessment at home, liaising with members of the multi-disciplinary team to set outcomes of care and promote independence at home. People will be discharged to mainstream services for ongoing management and care as appropriate.

Who can refer? Any healthcare professional, care home staff, pharmacists, GP, Scottish Ambulance Service, Hospital discharge team and Acute Frailty Team

How do we work?
• All calls are triaged, and referrals will be assessed by the cluster nursing team initially. Where an advanced clinical assessment is required, this will be undertaken by an ANP or CNS with medical responsibility remaining with the GP.
• The ANP or CNS will communicate the assessment and plan of care to GP using Vision, or in person if clinical advice or referral to specialist services via SCI Gateway is required.
• Our cluster nursing teams can admit to hospital, contact specialist clinicians for advice or escalate care to DEC@HT Consultant Geriatrician if indicated.
• The DEC@HT Consultant Geriatrician will only see people if this has been triaged as being clinically indicated by any of the nursing team.
• If accepted onto Geriatrician case load, this will be communicated to GP via Clinical Portal and a discharge letter will be issued when medical responsibility returns to GP.

Who to refer

1. Patients requiring a comprehensive nursing assessment and co-ordinated approach to care:
Same Day
• Infection currently being treated by GP
• Acute exacerbation of existing long-term condition currently being managed by GP
• Recent discharge from hospital and at risk of re-admission
• Increased frequency of falls
2-4 Days
• Weight loss/unexplained or continued
• Reduced mobility and falls
• Functional decline
• Confusion (dementia/delirium) / deterioration in cognitive status
• Reduced oral intake
• Recent hospital discharge requiring monitoring of condition
Within 2 weeks
• At risk of falls
• Gradual functional decline
• CGA (Comprehensive Geriatric Assessment) required on discharge from hospital – non urgent
• Continence issues
 
2. Patients requiring assessment with a physical examination and prescribing if required:
Same day referral if before 3pm
• Likely undiagnosed infection / risk of sepsis
• Acute exacerbation of existing LTC requiring physical assessment
• NEWS 5-6 with unknown reason
• Unexplained acute functional decline
• Recently discharged from hospital and requiring further medical management
• Lower limb oedema of unknown cause
• Acute confusion without known cause
• Significantly reduced oral intake
• Investigations
• Requires Level 3 face-to-face polypharmacy review
 
3. Patients requiring a senior medical assessment due to more complex issues or conditions:
Same day referral if before 3pm
• Acutely deteriorating patient on brink of hospital admission
• Requiring access to specialist investigations
• Requires Level 3 face-to-face polypharmacy review
• Diagnosis unclear after GP assessment

Who not to refer

Exclusion criteria:
• End of life care without reversible cause of deterioration
• TIA or CVA
• Acute abdominal pain
• Head injury with loss of consciousness
• GCS less than 9
• Cardiac chest pain
• NEWS greater than 7
• Acute GI Bleed

How to refer

Care Home residents - Monday – Friday 09:00 – 16:00 hrs. Phone 01382 647296

People at Home
• Monday to Friday 09.00 - 16.00 hrs. Phone 01382 423186
• For urgent referral to the nursing team (including Public Holidays) - Monday - Friday 16:00-18:00, Saturday - Sunday 08.30 - 15:00. Phone 07776465742
• for non-urgent referrals please e-mail completed referral form to:
• Clusters 1 and 2 - Tay.decahteast@nhs.scot
• Clusters 3 and 4 -
Tay.decahtwest@nhs.scot

Useful resources and information