CRIS Team (Community Rapid Intervention Service Team) - Hospital care delivered at home

Dr Georgy Jacob, Consultant Geriatrician & Clinical Lead for the Department for Older adults, University Hospital of North Midlands. Leslie Roberts, Senior Operational Manager, CRIS Team, University Hospitals of North Midlands NHS Trust.

Care closer to home is a familiar term for Geriatricians. Emergency attendance and acute hospital admissions have been steadily rising over the last 10 years and this, coupled with a reduction in inpatient beds across acute and community sectors, has led to challenges in managing capacity in many acute Trusts.

In North Staffordshire, these challenges led to a review of community services for older adults to reduce hospital admissions. In the past, these services were provided by community teams comprising advanced nurse practitioners, district nurses and therapists with support from GPs, which is the model that is present in many parts of the country. However, we found that one of the drawbacks of this model was the lack of specialist input in managing these complex patients. This was addressed by a new model of service - the CRIS (Community Rapid Intervention Service Team) - consisting of advanced nurse practitioners (ANP) from acute and community services working under the supervision of hospital consultants (one Geriatrician and one Acute Medicine consultant). When we first got involved with this project, we had some reservations about how patients could be reviewed virtually by the consultants and around clinical governance. We decided to pilot it in order to refine and develop the model as we went along.

The CRIS team accepts referrals for subacute conditions (chest infections, urinary infections, falls, delirium, COPD exacerbations, cellulitis, medication-related problems, wound infections etc) from GPs, care homes, paramedics and NHS 111. After initial triage, the ANP will go out and assess the patients and discuss and agree with the consultants as necessary the investigations and management.  Patients seen by the team and requiring treatment are admitted into a virtual ward of the acute Trust (University Hospital of North Midlands) and patients are reviewed virtually by the CRIS consultants with twice daily virtual board rounds.

Over 80% of patients seen by this service were over 70 years and the team has been able to avoid A&E attendance or admissions by treating them in their own home or care homes in the vast majority of cases. After discussion with the CRIS consultant, if patients need further assessment or admission, they will be accepted through the assessment unit at the acute Trust. The service which has now been running for over 18 months has seen around 6000 patients and the service is expanding to become a pan-Staffordshire service. The team consists of call handlers, clinical triage nurses, advanced nurse practitioners and hospital consultants working in partnership. The advanced nurse practitioners have come from a variety of backgrounds - district nurses, physiotherapists, occupational therapists and paramedics, which adds to the skill mix.

The CRIS team has also risen to meet the challenges of the COVID-19 pandemic, assessing suspected or confirmed COVID patients at the request of GPs and managing them at home. The CRIS team is constantly developing and taking on new roles as well as using digital technology and has won a Trust award for partnership working.

The CRIS team is an excellent example of partnership working between the acute sector and community partners that helps to provide high quality care to patients at home without requiring acute hospital admissions.