Ipswich and East Suffolk’s Reactive Emergency Assessment Community Team (REACT) is a rapid and multidisciplinary response team created to integrate existing admission avoidance services and stop crisis admissions.
Until 2017, the Ipswich and East Suffolk Admission Avoidance offer comprised five successful but separated admission avoidance services: Crisis Action Team, Frailty Assessment Base, Emergency Therapy Team, Admission Prevention Service, and Outpatient Parenteral Antibiotic Therapy Service. Each of these services struggled with similar issues:
- Limited capacity in each team
- Declined referrals due to capacity limit
- Duplication of assessments and no trusted assessor
- Different IT systems
- Restricted referral criteria
REACT was introduced to bring these services into one fully integrated, centralised admission avoidance team covering front door services and community with 8am-8pm therapy support and 24/7 nursing and generic worker support.
The REACT service offers:
- Crisis response dispatched into the community within two hours of referral
- Up to four reablement carer visits daily and night sits
- Support for up to five days
- Out of hours nursing and IV antibiotic service
- Comprehensive Geriatric Assessment for patients in the Frailty Assessment Base, located on the acute site
- 15-minute response time for therapy admission avoidance assessment in emergency department
Currently, REACT includes nurses, a mental health specialist nurse, trainee advanced clinical practitioner, physiotherapists, occupational therapists, therapy assistant practitioners, health and social care practitioners reablement workers, health care assistants and social workers, and is also supported by the British Red Cross and Suffolk Family Carer support workers. The service receives two sessions of geriatrician support per week and five hours of Nurse Consultant attendance at multi-disciplinary teams per week.
In 2019, in partnership with Ipswich Borough Council, REACT introduced Raizer chair community lifting equipment for emergency falls response, helping to optimise admission avoidance opportunities pre-ambulance, with referral directly from the East of England Ambulance Service NHS Trust control room. As part of this work, training was given to community responders to increase awareness of the REACT service and which patients should be referred. REACT also worked with the mental health provider, Norfolk and Suffolk NHS Foundation Trust, on mental health integration and a Dementia Intensive Support Team was added to the REACT model to increase provision for mental health support. In 2020, a new Care Home Initiative was also introduced to the REACT service offer.
The REACT model was also enhanced and integrated with Ipswich and East Suffolk’s eight Integrated Neighbourhood Teams (INTs) during the pandemic. REACT provides a centralised clinical triage and localised responses are delivered within two hours by INTs, or by REACT in the case of more complex crisis referrals. This move to localising care enables fewer handoffs, seamless service for the patients, reduced deconditioning of patients, care to be provided closer the home and a reduction in travel time allowing the optimisation of face to face time.
The introduction of REACT resulted in:
- Achievement of an average of 23 avoided admissions per day
- Annual net cost avoidance of around £3.8million
- Removal of duplication of assessments between acute and community
- Reduction of declined referrals from 27 per cent to below 3 per cent (at the point of introduction)
- Enhanced flexibility in management of resources to meet demand, and movement of resources from acute setting to community
- Co-location of integrated health and social care alongside the voluntary and community sector, leading to fewer handoffs and a greater focus on the patient pathway
This redesign of admission avoidance services has benefitted patients and families, with REACT receiving a combined score of 98 per cent across the NHS Family and Friends Test. It has also received consistently strong feedback from staff working within the team.
How is the new approach being sustained?
In some ways, REACT can be described as a victim of its own success as the ‘no wrong door’ policy, with one phone call to refer, can lead to the redirection of referrals to REACT from other services which do not cover seven days or extended hours. Furthermore, as a 24-hour service, the model has experienced issues with recruitment and staff shortages, though REACT receives consistently strong feedback on staff satisfaction due to the opportunity for multi-disciplinary working and enhanced career opportunities.
These issues are being addressed to build the model’s sustainability, to enable it to meet expected increases in demand in the next five to 20 years. Substantial growth in the over-65 population and increased prevalence of dementia will necessitate change in how REACT works and multiple alternative models are being investigated, including fully integrated community care, through more remote working and localised care delivery. Options for digitisation and remote working were already being explored before the pandemic to reduce time staff spent travelling back to base in Ipswich, due to the rural geography of East Suffolk.
The REACT team have developed the model successfully through small, incremental gains rather than rapid transformation of these services. Each time a new change or addition to the model is introduced, they work to promote confidence in the model and prove its value, so that they can continue to address existing challenges and meet the future needs of the population.
Every time we add to the REACT concept, it is like resolving another issue upstream of the dam"