Our team of occupational therapists, physiotherapists and nurses, the Rapid Emergency Assessment Care Team (REACT), works with emergency staff at the Bristol Royal Infirmary to support patients to go home instead of being admitted to hospital. By Amy Holgate
There is a traffic jam in the bustling corridor of the Emergency Department at the Bristol Royal Infirmary (BRI). A patient is being carefully pushed in a wheelchair to the observation room; an empty trolley is on its way to a new patient; and there is a cleaning trolley going… well, everywhere. With a bit of expert manoeuvring, a few chuckles and a lot of coordination everyone goes on their way. It’s a small moment of collaboration but a sign of the huge mutual respect between these multi-skilled clinicians who work together to give the very best emergency care for their patients.
Most staff in the Emergency Department are employed by University Hospitals Bristol NHS Foundation Trust, but Bristol Community Health has a multi-disciplinary team called REACT which is based here at the BRI and also at Southmead Hospital. This team is made up of occupational therapists (OTs), physiotherapists and nurses, with support from Advanced Practitioners. They work closely with emergency staff to assess patients and establish whether they are able to go home, rather than be admitted to a hospital ward.
Amanda Bennett is REACT’s manager and an OT. “Turning up in the Emergency Department can be a stressful experience for patients,” she says. “Often they have experienced trauma and don’t know what to expect. We support them and help them understand what’s happening.” Together with the patient, REACT makes a plan for the next step, whether it’s returning home, referral to a community or voluntary support service or admission into hospital. As Amanda puts it, “We are the patient’s bridge from the hospital back into the community. I feel very privileged to be let into people’s lives in the way that I am.”
Amanda is talking about the work she does on the way to see an 82-year-old patient called Hazel, who has been brought to the Minor Injuries Unit after falling in the wet weather. The patient list on the ward whiteboard has REACT next to many of the entries. In the short time I’m with her she has three more referrals come through; a passing registrar from the hospital murmurs to me, “They’re worth their weight in gold, this lot.”
Hazel fell over yesterday but has been kept in overnight. “We have to be careful with people who fall,” says Amanda. “Some things can get masked by adrenaline so what happens afterwards is key. But there are no broken bones and her head scan was clear. It was a ‘mechanical’ fall, which means there wasn’t an underlying health reason for it, thankfully.”
We are the patient’s bridge from the hospital back into the community.” Amanda Bennett, REACT Team Manager and occupational therapist
But there are some other things Amanda needs to see to before Hazel can go home. She has tried to contact Hazel’s only ‘family’ member in the UK, her godson, to tell him about the fall, but no luck so far. Hazel lives alone, so Amanda needs to make sure that Hazel can still manage her stairs. Amanda and Sarah, a physio from REACT, push her in a wheelchair to the hospital’s purpose-built gym which has a mini flight of steps she can practise on. They carefully arrange a blanket to cover her knees before they go.
On the way, Amanda and Hazel laugh about how, with a bit of practice, Amanda managed to twist Hazel’s hair at the back in the way she likes. “You taught me how to do it, didn’t you? I’m very pleased with myself!” says Amanda.
With her OT’s empathy and flair for cracking problems, Amanda has also picked up a few things that are making Hazel’s life harder at home and leaving her vulnerable. She’s looked at her records and seen that various Bristol Community Health teams and other community organisations have helped in the past with the basics: she has a key safe, an extra stair rail, a Lifeline button. But as time has gone on Hazel now isn’t able to get into her bath and has no shower, and is feeling distressed about not being able to wash. Amanda gave her a wash when she came in. “I think she felt a lot better after that,” she says, “and she loosened up a lot too.”
I couldn’t do without these people… Everybody took me in and helped.” Hazel, patient
To help Hazel get a walk-in shower at home, Amanda contacts local social care services and arranges for an advocate to visit her at home. She’s managed to track down the same person who has supported Hazel in the past. Amanda also discovers that Hazel’s boiler is broken and she can’t make head nor tail of the council’s repair forms. Amanda contacts the social worker who will be able to help with the paperwork and make sure she’s warm for winter.
Hazel is diabetic and has been struggling to monitor her blood sugars herself – she’s scared of needles. Amanda refers her to the community matron to monitor her blood sugars and review what else she needs to manage the condition. Then she makes a few phone calls to the Red Cross to organise a short-term home shopping service, plus another call to Hazel’s godson.
At the gym, Hazel gingerly tackles the staircase – up, a little turn at the top and back down again. Amanda is close, arms wide, ready. Hazel is careful, but manages without help.
Back to the unit, and it’s nearly time for her to go home. Amanda books her transport and gets Hazel ready, helping her get dressed. As she gently bustles around she is also carefully probing and I know she is doing everything she can to be satisfied that Hazel will be safe at home.
Are her pills in a sorted box or in their original packets? Are they regularly delivered? Has she got food at home? Has her key safe got her key in? Does she feel ready to go home?
Hazel looks up at me and says: “I couldn’t do without these people. That is the truth. I’ve never had anyone here refuse me. Everybody took me in and helped.”
Catching up with Amanda on the phone a few days later, I discovered that she had managed to get in touch with Hazel’s godson. “He was completely lovely,” she says, “and very pleased that I’d called him. He’s on his way up for a visit.”
What is REACT?
The Rapid Emergency Assessment Care Team (REACT) is co-located with emergency departments. It makes holistic clinical assessments to understand what brought patients to the emergency department and facilitate a safe and timely discharge. The team has close links to community teams such as Rapid Response. By helping to stop patients – who are often elderly – being admitted onto other wards unnecessarily, REACT helps to reduce pressure on local hospitals.
“REACT is a dynamic team with expertise in the assessment and management of elderly and frail patients presenting to the Emergency Department. The team’s input is invaluable when attempting to decide whether discharge from hospital is safe and appropriate. Their consideration of ongoing care also leads to interventions that can prevent or reduce attendance to the Emergency Department. We really value the work that they do.” Dr Rob Stafford, Consultant in Emergency Medicine and Clinical Lead, Bristol Royal Infirmary Emergency Department, University Hospitals Bristol NHS Foundation Trust