The Royal Marsden

HARI

Holistic Assessment Rapid Investigation

The Royal Marsden

HARI Definition

A multidisciplinary community service for adults with complex

medical and rehabilitation needs

The Royal Marsden

The Royal Marsden

HARI Vision

– Keeping people well– Prevent unplanned hospital

admissions – Reduce the risk of falls – Enable independent living

– Rehabilitation  

The Royal Marsden

Referral CriteriaPatients:

– registered with a Merton GP

– aged 18 years +

– requiring therapeutic intervention from more than one health professional including: Consultant Physician; Advanced Nurse Practitioners; occupational therapists; and physiotherapists. Pharmacist – coming soon!

– with mental capacity to participate in group and individual based rehabilitation

–Complete single referral form SMCS website – tick “HARI”or “rehabilitation”

–Provide information to outline anticipated patient outcomes and choose an appointment with an appropriate health professional if known

–Transport can be offered for those unable to travel independently

The Royal Marsden

The referrer can select a choice of 2 service options:-

1. A full assessment by the whole team including a full Consultant/ANP assessment, plus therapy assessment, falls screening and rehabilitation.

For this pathway, referrals can only be made by the GP

2. For those requiring rehabilitation only, referrals can be made by GPs but also directly from SMCS rehab teams e.g. Rapid Response, Falls Prevention Service and also, if appropriate, patients with Parkinson’s Disease will automatically be reviewed on a 4 – 6 monthly basis team

Patients will be offered a routine appointment within 10 working days

HARI Referrals

The Royal Marsden

Meet the HARI team

• Consultants Physicians• Advanced Nurse Practitioners• Nurses• Health Care Assistant• Occupational Therapists• Physiotherapists• Rehabilitation Assistants• Administrators• Pharmacist – coming soon• Podiatry – Regular sessions

The Royal Marsden

Assessment and InvestigationThe team will provide assessments, request investigations and formulate management/ care plans

–Holistic – reviewing patients, carers and their needs

–With Advanced Nurse Practitioners, consultants, physiotherapists and occupational therapists

–Investigations, as required, can be organised during the initial visit or with subsequent visits

The Royal Marsden

HARI Rehabilitation

• Based at the Nelson Health Care Centre• Assessments are carried out at the Nelson and

therapists also assess in patients’ homes.• Patients have the option of a morning or

afternoon session• On arrival patients are offered a hot drink and

have their nursing observations before commencing therapy

• AM therapy sessions start from 9.30 – 11.30• PM therapy sessions start from 13.30 – 15.30

The Royal Marsden

Rehabilitation: Occupational Therapy

– Full Occupational Therapy Assessment – seeking to promote independence at home and within the community.

– Home Assessments to assess an individual’s functional ability within the home to assess for home hazards and reduce the risk of falls.

– Prescription of specialist equipment to promote independence– Wheelchair assessments and practice– Moving and Handling Risk Assessments– Upper limb and Hand Assessments and hand rehabilitation– Orthotic Fabrication– Cognitive Assessment– Anxiety Management Training, psychological support and the

promotion of wellbeing and healthy lifestyle choices– Health Promotion and advice for patients and carers

The Royal Marsden

Rehabilitation: Physiotherapy

– Full Physiotherapy assessment including balance, strength, mobility and falls assessment.

– Gait assessment and re-education including outdoor mobility practice– Provision and review of walking aids– Individual and group exercise within gym

environment– Home assessments to review mobility – Home exercise programme– Onwards referrals to Falls Prevention Service

and Community Support Services

The Royal Marsden

Falls Service Provision

Three key teams provide the SMCS Falls Service

• Holistic Assessment & Rapid Investigation (HARI)

• CRISIS/Community Rehabilitation Team

• Falls Prevention Service (FPS)

PLUS

Other Falls Pathway Teams

• Community Neuro-Therapy Team (CNTT)

• Rapid Response Team (RRT)

• Community nursing

The Royal Marsden

External Collaboration

The Royal Marsden

Internal Collaboration

The Royal Marsden

Patient Example

The Royal Marsden

Future Innovations

–New HARI pharmacist to support medicines optimization

–Improve links with Mental Health Services including links with new Dementia Nurses

–Currently recruiting 2 new Occupational Therapists to link in with the above and 1 new Physiotherapist.

The Royal Marsden

The Royal Marsden HARI – Holistic Assessment Rapid Investigation18

Contact details

Referral Queries-Adult Referral Centre

Sutton and Merton Community Services Administration Centre

Tel: 0845 567 2000

HARI Queries – to speak to a clinician

HARINelson Health CentreKingston RoadRaynes ParkLondon SW20 8DB

Tel: 020 8245 8240