Camden Rapid Access Services (RAS) incorporates three pathways:

• Urgent Community Response (UCR, previously Rapid Response)
• Virtual Ward (VW, consultant geriatrician-led acute care)
• Discharge to Assess (D2A), a therapy-led hospital discharge service.

Urgent Community Response

The UCR service offers attendance by a senior nurse, paramedic, physiotherapist or occupational therapist within two hours of referral for acute/sub-acute medical needs.

The service carries point-of-care machines which provide numerous blood results within two minutes of processing (Hb, Hct, Na, K, Glucose and others), as well as ECG machines and bladder scanners. Advanced nursing care is also offered, including physical assessment and non-medical prescribing.

Examples of suitable conditions include:

• blocked catheter
• carer breakdown (direct access to a Camden adult social care worker)
• cellulitis
• chest infection
• COPD exacerbation
• COVID-19
• dehydration
• delirium (with possibility to provide overnight sitters for three or more nights)
• falls
• frailty
• haematuria
• head injury (simple, requiring dressing, not glue or sutures)
• heart failure
• unstable diabetes
• UTI (the service does not dipstick the urine of 65+ year olds to rule infection in or out)
• patients who require hospital admission but refuse to go (patient must be aware that the RAS service would provide a sub-optimal clinical outcome).

This is not an exhaustive list and, if uncertain, call the nurse/paramedic in charge to discuss the patient's needs.

Virtual Ward

Patients for the Camden Virtual Ward (VW) are to be referred via the UCR pathway - if during UCR visit(s) patients are identified as having additional needs, they will be escalated internally to the VW consultant geriatrician. The service has 15 consultant-led VW beds.

Camden's VW offers consultant geriatrician-led care for older people living with frailty in the community, who would otherwise be admitted to acute hospitals. In addition to the usual care that is on offer from UCR (e.g. therapies, nursing, 24-hour care, etc), VW's offer consultant input, which can include home visits. Typical patients will be older people living with frailty in crisis, including, (falls with or without injuries), delirium, heart failure, and/or infection. 

The target population are Camden residents who are pre-medically optimised or at high risk of immediate (re-)admission and have an expected length of stay in Camden VW of up to 14 days or less. The service will case manage patients during their stay under VW and make necessary referrals.

Ten nurse-led beds are also available within the Camden VW, enabling early supported discharge.

Falls pick-up service

Camden RAS offers a therapy-led falls pick up service. If patients are on the floor and have no obvious injuries, the service is able to attend the patient's property and pick them up using specialist equipment. A therapy review will then be provided, with nursing/paramedic input also available, if needed, to investigate the cause of the fall(s). For patients who self-refer to this service, the team will contact the GP practice/111 prior to visiting to ensure the GP is happy with the team accepting the patient.

Blood tests

RAS nurses are able to interpret common bloods such as FBC, U&Es, CRP and Ddimer. Outside of these, others will only be taken if requested, but the interpretation responsibility will remain with the referring practitioner and/or the GP.

Discharge to Assess (D2A)

The Discharge to Assess model works on the principle of making sure patients do not stay in a hospital bed for any longer than they need to. Patients are discharged as soon as their acute medical treatment is complete and all assessments are followed up within the community, after discharge. 

The Discharge to Assess model focuses on a 'home first' principle and is comprised of three different pathways, with all referrals accepted from any hospital and processed by the Integrated Discharge Team (IDT).  

• Pathway 3: for patients being transferred to long-term care such as a residential care home or nursing home. 
• Pathway 2: discharge for patients to an alternative location that isn't home, for a short-term period for rehabilitation and reablement, before returning home.
• Pathway 1: for patients going home from hospital, the team consisting of occupational therapists, physiotherapists, social workers, therapy assistants and support workers. This pathway is operated in conjunction with Camden Adult Social Care with any same-day therapy assessment that is required for the patient undertaken by the Rapid Access Services therapy team. These assessments will be based around the patient's level of function, environment and care needs to ensure they remain as independent as possible at home. By assessing the patient at home and not on the ward, the setting is more appropriate as the environment is familiar to the individual, but gives a sense of functional capability and environmental challenges. It also prevents decisions about long-term care being made in crisis and gives insight into how patients cope, giving the professional an accurate assessment.

Service leadership

• Gareth Turner, Lead Therapist
• Jo Hamilton, Deputy Lead Therapist
• Christine Mitchell, Lead Nurse (non-medical prescriber)
• Fatima Bhatti, Deputy Lead Nurse (non-medical prescriber)
• Dr Alex Tsui, Consultant Geriatrician, Camden Virtual Ward

Eligibility Criteria

Inclusions

Adult patients (aged 18+) requiring immediate health or social care treatment who can be managed at home (or are in a nursing/residential care home) to prevent admission to hospital.

Additionally, those who:

• are a Camden resident or registered with a Camden GP and living in Westminster or Brent within one mile of the Camden border
• are non-housebound or housebound
• would likely avoid admission to hospital (A&E or main frame) if RAS has input (if not at risk of admission, not suitable for service).

Exclusions

• primary presenting complaint of a mental health nature or due to drug/alcohol abuse
• emergency conditions requiring 999/A&E
• home environment unsafe for visiting practitioners
• decline/refuse service/do not consent
• not at risk of admission to hospital (A&E or main frame)
• not contactable by GP (you must have spoken with the patient prior to referring to the service to make them aware of the team's attendance and to gain consent for the referral).

Please note: The VW has additional inclusion and exclusion criteria, but this is managed internally. 

Self-referrals from patients or their unqualified carers are no longer accepted to the UCR pathway unless known to the team within the last 48 hours and with the same clinical presentation. This is in response to a number of self-referrals being inappropriate and using up resources, patient safety and follows similar agreements in other NCL boroughs and pan-London.

How to Refer

Locations

Camden Rapid Response Admission Avoidance Service