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Clinical Recovery and Support Unit at Nenagh Hospital

CRSU Nenagh Multidisciplinary Team - ULH
Members of the multidisciplinary team involved in the Clinical Recovery and Support Unit at Nenagh Hospital Prof Mike Watts, Consultant Physician; Dr Sara Gwiazda, SHO, Nenagh Hospital; Michelle O’Connor, Occupational Therapist; Catherine Martin, Discharge Co-ordinator; Aoife Synnott, Physiotherapist and Bryan Jones, Medical Social Worker

An initiative at Nenagh Hospital is allowing patients with complex care needs access enhanced supports from allied health professionals as they continue their rehabilitation and recovery.

The Clinical Recovery and Support Unit (CRSU) identifies patients who have been in University Hospital Limerick for longer than 30 days but who no longer need to be in the region’s only model 4 hospital. As well as helping the patients themselves move to the next stage of their care and recovery, the initiative improves patient flow within the wider UL Hospitals Group.

The new service comes under the clinical governance of consultant physician Prof Mike Watts and is supported through the recruitment of 4 WTE (whole-time equivalent) additional therapists (physiotherapy, occupational therapy, speech and language therapy etc) and medical social workers.

Prof Watts, Clinical Lead, Unscheduled Care, UL Hospitals Group, explained:

“When I meet with patient flow and bed management staff, one of the issues we often talk about is those patients who have been in UHL for more than 30 days. These are patients for whom there has unfortunately been some bump in the road – either a clinical one or in their rehab or some factor relating to their discharge – where they have remained here in our model 4 hospital in UHL.

“For many patients, for any number of good clinical reasons, they absolutely need to remain in UHL. However, we have identified another group of patients who do not need to be in UHL but who do need to be cared for somewhere to have their issues resolved. These issues may relate to supported discharge, to access to the National Rehabilitation Hospital in Dun Laoghaire, or to medical issues such as prolonged intravenous antibiotics or recovery from an amputation, for example. This group of patients no longer need to be cared for in the big acute hospital but somewhere else that is equipped to care for them and that is the key thing. And that is where the idea of the Clinical Recovery and Support Unit at Nenagh Hospital came from,” said Prof Watts.

On any one day, there can be between 50 and 60 patients in UHL whose length of stay has exceeded 30 days. It is envisaged that, over the coming months, Nenagh can accommodate up to 10 of these patients where their care needs match the criteria of the CRSU. Nenagh Hospital has 48 inpatient beds and has generally more modern inpatient accommodation than is available to patients at UHL. In addition, Nenagh Hospital has the dedicated and highly skilled teams of nursing staff who are essential to delivering care to this more complex group of patients.

Additional allied health professional resources are being put in place in Nenagh and patients have begun to be transferred to the CRSU. This transfer can only take place with the consent of the patient/relatives and of their treating clinicians in UHL.

“It was key to the business case that we would have additional allied health professionals in place so we could deal with the rehabilitation issues of the patients still in hospital as we worked with colleagues in the community on discharge planning,” said Prof Watts.

While a certain number of patients in the CRSU will be transferring to the National Rehabilitation Hospital or other care settings, it is envisaged that the majority will be discharged home.

“I will be doing rounds in Nenagh once a week and we will meet as a multi-disciplinary team to discharge plan and set goals and help the patients to recover and move on. This group of patients may have complex discharge needs but, away from the extremely busy environment of UHL and with the improved access to therapies available in Nenagh, I believe there will be a better focus on those needs including the social care needs of some patients,” said Prof Watts.

“We need to look at the long-term for our model 2 hospitals and where they can play a hugely important role in meeting the needs of our rapidly ageing population. In the MidWest, we are unique in that we have one model 4 and three model 2 hospitals. There are 10 model 2 hospitals in the country and we have three of them, constituting half of our total medical beds. We are in a situation where 150 of our medical beds are in our model 2 hospitals, which don’t have anaesthetic cover. In addition, we have one of the most pressurised hospitals in the country in UHL and we need to look at using the medical beds in the model 2 hospitals in a smarter way. The Cataract Centre has been very positive for Nenagh Hospital on the surgery side and I think the CRSU potentially could come to be viewed in a similar way. It is a small step to begin with but once we begin to collect our data, we hope to be able to reduce the number of long stays. If we can adjust for demand and show the model is working, there is no reason why we cannot take a similar approach in Ennis,” said Prof Watts.

The launch of this initiative delivers an important immediate dividend for all patients in Nenagh, who will also benefit from the increased allied health resources.

Fiona Steed, Allied Health Lead, UL Hospitals Group, said: “This initiative has allowed us to bolster the allied health staff at Nenagh hospital and provide improved quality of care and better patient outcomes throughout the hospital. The occupational therapy, medical social work staff and, in the near future, speech and language therapists will work alongside and complement the existing physiotherapy service and emerging dietetics service. Having a full multi-disciplinary team at Nenagh Hospital will be of enormous benefit to all.

Paula Cussen Murphy, General Manager, Unscheduled Care, UL Hospitals Group, said: “We are delighted to move forward with this development for the people of the MidWest. It is an important initiative for patients and enables us to move patients to CRSU to continue their ongoing care and discharge planning while making beds available for the next acute admission in UHL”.

Cathrina Ryan, Operational Director of Nursing, Nenagh Hospital, said: “The allied health professional support that has been secured with this initiative is of great benefit to all patients being cared for in Nenagh Hospital. It is also a great advantage to have structured multidisciplinary team meetings to adequately review and plan next stages of care. The varied and complex care needs of these patients are a great opportunity for staff to develop their skills with enhanced training and development to enable these patients to be cared for in Nenagh Hospital.