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Nursing research with big impact: How one frailty intervention has become an essential part of reducing hospital admissions

Nursing research with big impact: How one frailty intervention has become an essential part of reducing hospital admissions

An interview with Dr Abigail Barkham, Consultant Nurse for Frailty, Visiting Fellow University of Southampton, NIHR 70@70 Senior Nurse Research Leader.

Back in 2019 I began a pilot programme to assess the impact that we could have on hospital admission rates for service users living with frailty. Our aim was to demonstrate that with early intervention, we could keep older people living with frailty out of hospital to ease pressure on the system. Little did I know at the time, how important it would come to be in 2020.

As the coronavirus pandemic came into focus in March 2020, my pilot was coming to an end. With some rapid analysis and evaluation, it became even more evident that it was vital to try and keep people at home. Thanks to the results of the pilot and the emphasis placed on reducing hospital visits because of the pandemic, our Community System was awarded
£3million of funding from the Clinical Commissioning Group to continue and expand the work.

Out of 315 patients in the study, only 39 were sent to hospital. We were able to meet our rapid response (two hour) target and 100% GP contact was avoided. This meant that we were able to step in and provide an add-on service to ease GP pressure, as well as
reduce hospital admissions.

This evidence gave us a solid base for completing a bid for funding and being confident of its success. The growing seriousness of the pandemic helped to strengthen our case for funding because it was so evident that we could help to reduce hospital admission rates, something that was essential to helping the NHS cope with the increased demand.

Applying our knowledge

As a nurse, it has always been a challenge to combine research and the practice of nursing. We don’t have dedicated research time allocated to our roles, so it’s something that is difficult to balance alongside a clinical career.

Programmes like 70@70 allow nurses and midwives to take their knowledge and apply it to research in ways that we wouldn’t otherwise be able to. Using our insight and skills we are able to spot gaps in service and care provision and create interventions that have a big impact.

The full service Urgent Community Response Team will employ 60 people across mid and north Hampshire with a mix of different skill-sets and clinical experience. We’ll be able to reach a lot more people and help to keep older people living with frailty in their homes, something that is also vital to their happiness and comfort levels.

Using our insight and skills we are able to spot gaps in service and care provision and create interventions that have a big impact.

Alongside bringing the frailty study into a fully-fledged service, I’ve been working with my Wessex 70@70 colleagues to create a conference in 2021. The idea is to host a range of different symposiums, by nurses and midwives, to look at all the different ways that nurses and midwives can get involved with research. We wanted to promote our work and encourage others, so we’re working closely with CRN Wessex to provide an online conference in June next year.

Encouraging others

I’ve been working closely with Paula Hull, Director of Allied Health Professionals & Nursing Southern Health, to create the Academy of Clinical Excellence which launched in November. Its aim is to support clinicians to create the career they want to achieve and to help them reach their career goals. I am leading the research arm of the academy and will be giving my time to coach people in their career pathway.

I’m also a supervisor at Bournemouth University for the Applied Research Collaboration
(ARC) Wessex Studentship and have been supporting a colleague to get her internship submitted. I think that 70@70 has given me a voice, and the ability to come to the table. I want to continue to raise the clinical research voice and grow the clinical research workforce long after the 70@70 scheme has finished.

The benefits of encouraging nurses and midwives into research are really clear for me to see. We are bringing about change. It’s really interesting that the pandemic has also pushed that change along far quicker than I ever could have imagined. There are so many research opportunities at the moment, that it has propelled nurses and midwives into an even stronger position.

I would encourage any nurses or midwives looking to get into research, to find someone in your organisation who has done a research journey. Talk to them. Find out how they did it and what their challenges were. It’s a great way to get started and a great way to get inspired about how much difference we can make.

About the frailty intervention trial

The trial was set up to establish if early intervention could reduce admission to hospital for those triggering a frailty syndrome in primary care. Admission avoidance has been an important goal for the NHS for a long time but it is also an important way of making patients happier and improving their quality of life.

The trial placed a team of on-call nurses and healthcare professionals in a two hour response team, working closely with local GP surgeries to step in and visit when a patient was identified as having additional needs that the GP alone could not solve. While attending, the team were also able to provide a holistic assessment of the patient and refer to additional healthcare providers where necessary, all without having to be admitted to hospital.