Pandora Wright is a geriatric registrar, currently working at Central Middlesex Hospital North West London NHS trust. This blog refers to a study she led whilst working in the Royal Free London NHS Foundation Trust 2010-12.
Hardly a week seems to pass without the media reminding us of the policy makers’ agenda: unplanned hospital admissions of elderly patients account for 80% of all NHS admissions, and perhaps because of their higher risk of medical and social complexity are seen as adding additional pressure to our already overstretched A&E departments.
Many NHS trusts have introduced their own emergency geriatric admission avoidance services. Last week, The BBC inside out team for BBC London News broadcasted from Croydon hospital A&E, where a new team was established to expedite discharge of older patients. Interestingly, the report was more focused on the increased flow through the department, and the A&E meeting it’s 4 hour waiting time target, rather than on the patient experience.
To date, evidence for the effectiveness of these services has been lacking and rather, has been established from best practice.
I was fortunate to be present at the inception of The Royal Free’s own geriatric admission avoidance system in September 2010. It was called TREAT (Triage and Rapid Elderly Assessment Team).
We tracked TREAT’s progress and impact over it’s first year of operation in a study published in Age and Aging online in August. It was easy to set up, using mostly existing resources, and realized early demonstrable benefits. After only 1 year, TREAT had achieved an 11.25% reduction in mean length of stay across all emergency geriatric admissions (not just those cherry-picked by TREAT).
The trick was to put a consultant led specialist MDT in the A&E to quickly select suitable patients who could be promptly discharged following a CGA and intervention in the A&E. The patients were followed up with a supported tailored discharge with a HOT clinic appointment within the next 5 days.
It combined proven admission avoidance strategies and discreet systems bundled into a system of care encompassing a specialist led MDT assessment in A&E, supported individualized and coordinated discharge and early rapid outpatient follow-up. It targeted those medically stable elderly patients with complex medical and social needs, which would otherwise have necessitated admission.