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Team working leads to new streamlined service for frail patients at Lancashire Teaching Hospitals

Innovative team-working across a number of local NHS teams has led to a new streamlined approach to admitting frail older patients to hospital while bypassing Emergency Departments.

Lancashire Teaching Hospitals NHS Foundation Trust has worked with a wide range of partners including North West Ambulance Service (NWAS), local GPs, and community frailty nurses to develop a new ‘direct admissions pathway’ created to provide easier access to specialist care.

In the first six working days of using the new system, five patients were admitted to hospital without attending an Emergency Department, while alternative arrangements were put in place to avoid hospital admission for one patient.

Lancashire Teaching Hospitals Lead Frailty Practitioner Hazel Wright said: “We are delighted to have opened up our unit to direct admissions from NWAS. This takes out the need for the patients to wait in the emergency department, and they have early access to a comfortable bed. 

“We use a multidisciplinary approach and complete a comprehensive geriatric assessment addressing not only medical, but also psychological, environmental and social aspects of care.”   

Development of the new pathway came about through the work of the ‘Frailty Big Room’, a project set up to drive innovation in services aimed at people with frailty issues.

The ‘Big Room’ concept brings together everyone involved in delivering a service to collaborate on finding innovative solutions.

Lancashire Teaching Hospitals Deputy Director of Nursing, Midwifery and Allied Health Professionals Catherine Silcock said: “Development of this new pathway reduces pressure on our Emergency Departments and ensures patients with frailty issues can get timely and efficient access to the care they need.

“This is innovative, shows joined up working, is best for the patients and I am very proud to work with such an inspirational team.”

The Frailty Big Room has been meeting since July 2019, bringing together a GP, community frailty nurses, NWAS, along with managers, allied health professionals, nurses, consultants and junior doctors from Lancashire Teaching Hospitals to collaborate on finding new solutions to for patients.

Catherine said: “The principles of working in this way includes a flattened hierarchy, because it is important that we work collaboratively to reach consensus on how to improve the way various services and teams work together.

“Only those immersed in the work can drive the improvements and it is always about patients first.”

North West Ambulance Service clinical lead for the initiative, Advanced Paramedic Shaun Tierney, said: “We see many older people in the community who would benefit from the support of the team on the Acute Frailty Unit.

“This direct route means they don’t have to wait to be seen in the Emergency Department, which is a better experience for the patient and makes sure they get the right care more quickly.

“This is a great example of working together to provide the best care for our patients.”

The new direct admission pathway is the latest improvement developed by the Big Room Team.

Other developments introduced by the Big Room team have included the opening of a 10-bed Acute Frailty Assessment Unit at Preston Hospital, launch of daily team meetings involving community staff and development of a virtual frailty ward.

People who need to access medical care or advice should call 111, or 999 in an emergency.

Get in touch

Chorley and South Ribble Hospital

Preston Road



01257 261222

Royal Preston Hospital

Sharoe Green Lane




01772 716565

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