Enhanced Therapeutic Observations and Care

Enhanced Therapeutic Observations and Care (ETOC), also known as Enhanced Care is additional support provided to some patients while they are in hospital to help keep them safe and well. It is sometimes also called Enhanced Observation or 1-to-1 care.

If a patient needs Enhanced Care, a member of staff may be allocated to provide closer observation and support, often on a one-to-one basis. This helps reduce the risk of harm to the patient or others and supports recovery during their hospital stay. ETOC is part of a patient-centred care plan and is used only when needed, based on a multi-disciplinary team assessment carried out by professionals involved in the patient's care.

A patient may require Enhanced Care for a variety of reasons, including if they are

• confused, distressed or agitated
• at risk of falls
• have dementia, delirium or cognitive impairment
• have a mental health need requiring intensive support, such as a risk to their own safety or the safety of others, distress or vulnerability to harm
• have a learning disability or autism that makes the hospital environment challenging
•  are pulling at medical lines or dressings; or
• are vulnerable due to changes in their physical or mental health.
  
  The aim is always to reduce risk and distress, while maintaining dignity and respect.

Enhanced Care may mean a dedicated member of staff stays with the patient for most or all of the time. The level of observation is tailored to individual needs and may involve staff remaining within eyesight or within arm’s length.

Staff will support the patient with personal care, eating and drinking, mobility and comfort, and will spend time talking, listening and engaging the patient in meaningful activity. Enhanced Care may be provided for part or all of a hospital stay, depending on changing needs.

Enhanced Care is provided by trained healthcare staff, including registered professionals and support workers. They work as part of the wider multidisciplinary team to ensure care is safe, compassionate and coordinated.

The need for Enhanced Care is decided following a multidisciplinary assessment which considers physical health, mental and emotional wellbeing, behaviour, safety risks and environmental factors.

The reasons for Enhanced Care are recorded in the patient’s care plan and reviewed regularly. Enhanced Care is reduced or stopped when it is no longer needed.

Families and carers know the patient best and are encouraged to share information about routines, preferences and what helps reassure the patient.

If available, documents such as patient passports or ‘All About Me’ information can help staff personalise care.

Enhanced Care is not a punishment and does not mean a patient is in trouble. It is used to support safety, dignity and recovery and is reviewed regularly.

If you have any questions or concerns about Enhanced Care or your relative/friend’s hospital stay, please speak to the nurse in charge of the ward or the ward team.

You can also contact the Patient Advice and Liaison Service (PALS) team for further support.