Home First Unit at Norfolk & Norwich University Hospital
In January 2022, Norfolk and Norwich University Hospital opened the Home First Unit (HFU). This is a 30 bed unit on Gunthorpe ward which has been specifically designed to facilitate medically fit patients, who cannot be safely discharged due to the substantial shortfall of care in the community.
Norfolk and Norwich University Hospital currently has over 200 patients who are medically fit for discharge, who some refer to as “bed blockers”. The phrase has been coined due to the knock on effect the situation has on the hospital that accommodates around 1200 beds. A shortage of beds isn’t a new anomaly, but with an increased rate of A&E admissions since post-lockdown, the public themselves may be noticing the extremely long waits in A&E of over four hours. This is the dangerous concern, as there may now be delays in A&E treatment for serious health events as medical beds are not available, which delays ambulances getting people into hospital for triage.
It is a complex and varied set of obstacles which is affecting hospital treatment, in which so called “bed blockers” is an arguably noteable source. We would like to demonstrate how Your Health Norfolk have been striving to improve the care of the patients on the HMU alongside the support of all the dedicated staff at Norfolk & Norwich University Hospital.
The work
In January 2022, we were approached by Tracey Fleming (AHP and Clinical Support Services Director) in hiring our services to support the prevention of deconditioning of patients on the HFU while they await discharge.
Deconditioning is very common during hospital admission, often patients becoming less mobile at discharge than their first admission. Rate of muscle loss can be 12% per week without use. Older adults in hospital can spend over 83% of their time either in their bed or chair. And with muscle atrophy occurring within the first 24-48 hours of disuse, we’re often playing catch up to regain this strength loss. Some patients have been in the hospital for over 4 months, so without the intervention of the HFU mentality, you can imagine the decline in patients’ mobility during their stay. By preventing deconditioning here, patient’s are less likely to return to hospital following discharge, thus freeing up beds for patients requiring medical intervention.
So, how does Your Health Norfolk help?
Your Health Norfolk specialise in exercise for older adults, specifically for the prevention of falls through means of strength and balance retraining exercises. Since February, our trainers have been working 30 hours per week on the HFU preventing deconditioning through exercise delivery. Medically fit patients are triaged by the physiotherapy team and passed onto our trainers to exercise. Often, this training is one-to-one at the patient’s bed-side, working on specific muscle building exercises to improve aspects of mobility that could be contributing to the patient’s sedentary behaviour. Patient’s transfer methods are noted on the ward handover, some patients may require physical assistance in order to walk, so we will aid this by completing laps of the ward by their side. However, the HFU ethos is to encourage independence, so we will support this when safe to do so. Patient’s engaging well are given exercise sheets and resistance bands to continue physical activity throughout the day.
Some patient’s mobility may have already declined by the time they have arrived at the HFU, whereby they require equipment to be used to complete transfers from their bed to chair. Some equipment you may be familiar with is a ross-return, stand-aid or full hoist. Our trainers have supported the physiotherapy rehabilitation plans for patients, by improving their mobility so that less complex transfers are required. As you can imagine, a family member acting as a carer may find the use of a full-hoist quite daunting to use at home, so a patient that is able to stand and move to their chair independently will require less physical support from their care-giver.
Our trainers have also been delivering seated exercise classes in the bays for patients. These are 30 minute sessions which work on a patient's flexibility, strength and endurance. Being on a hospital ward can be quite boring, frightening and lonely. We feel that getting patients’ into their chairs once per day and taking part in a group class is not only beneficial to their physical health, but helps create social cohesion where we often witness patients encouraging one another through the exercise and open discussions about their own thoughts on their current mobility levels.
Case Study
Julie was admitted to hospital in February following a fall at home which resulted in a fragility fracture. She eventually arrived on the HFU where she was experiencing high anxiety around falling again, thus requiring physical assistance of one to even walk to the bathroom. Julie was on the HFU for three weeks, in which time we worked with her to strengthen her lower leg muscle, improve her balance and increase her walking distance. Julie was discharged back home with 3 x per day care. But, Julie was very motivated to improve her mobility and understood the importance of exercise towards this. Since Julie’s discharge, she has been seeing our trainers privately in her own home twice per week for one-to-one exercise. Julie has improved tremendously during this time, she is even now walking down the road again to see her son and grandchildren on the weekends.
In August 2022, our services were expanded to several other wards within Older People’s Medicine to continue with the prevention of deconditioning through the means of exercise. Although Your Health Norfolk’s key objective is the prevention of falls, we understand how recovery from injury or illness is as equally beneficial to one’s well being. For more information on our services, advice or general enquiries, please contact us today on 01603 339 026 or email us at info@yourhealthnorfolk.co.uk.
