CATUs were set up at the start of the pandemic to protect patients with frailty from COVID-19 and other nosocomial (hospital-related) harms, including deconditioning and delirium. The pandemic public health messaging created a situation where older patients with frailty were isolated and confined to their homes for long periods of time.
Patients can be referred into a CATU via numerous routes (including an ambulance trust, an acute GP service and ED). Patients are triaged, medications are reviewed, and a discharge plan is created on admission, with an aim to turn around patients within 72 hours. There is also an intention that therapies should engage with patients within 24 hours of arrival.
Once assessed, the patient is admitted and given the treatment they need. The majority of CATU care is delivered within the CATU, although patients must also be transported around the county for some tests. The CATUs offer various activities to support recovery to a point where the patient is medically fit for discharge and to prevent deconditioning. Once patients are medically optimised, they are readied for discharge.
The evaluation has a mixed-methods, developmental design and incorporates findings from:
interviews with staff and stakeholders across the health and care system
system and locally collected referral and admissions data
place of referral data audits
patient engagement and patient experience case studies
informal qualitative feedback through community of practice sessions and stakeholder workshops
CATUs offer an alternative referral route for frail patients with urgent needs enabling patients to avoid acute admissions and often avoiding the hospital altogether, with South Western Ambulance Service NHS Foundation Trust (SWASFT) taking referrals directly to the CATU and avoiding ED.
Length of stay within a CATU is largely dependent on referrals being appropriate and care being available in the community, making the 72-hour turnaround target difficult for the CATUs to meet.