Enhanced observation in acute hospital settings: transforming care from reactive supervision to therapeutic...

Management of patients who experience agitation or confusion in acute hospital settings, particularly those with dementia or delirium, can involve one-to-one supervision, often undertaken by a bank or agency healthcare support worker, and sometimes supported by security personnel. In England, national guidance advocates a move away from passive supervision towards active therapeutic engagement centred on an Enhanced Therapeutic Observation and Care (ETOC) model. This article details a service improvement initiative that implemented an ETOC model in one trust in England. The initiative was led by a dedicated nursing team and involved utilisation of healthcare support workers - trained in person-centred dementia care, mental health care, therapeutic interventions and de-escalation - to deliver the intervention on acute wards in the trust. Since implementation of the ETOC model, trust data has shown a reduction in one-to-one observation shifts, associated bank or agency staff expenditure and use of security personnel, as well as no increase in patient falls, injuries or safeguarding concerns. This initiative demonstrates that dedicated clinical leadership and therapeutic engagement during enhanced observation can help to reduce restrictive practices and enhance the care of patients with dementia or delirium in acute hospital settings.