Creating a ‘Frail Friendly’ Acute Medical Unit… ‘not rocket science’

Teresa Dowsing trained as a physician associate at the University of Birmingham Medical School. She has worked in geriatric medicine for around 7 years and is the Frailty Lead for the George Eliot Hospital NHS Trust. To read more about physician associates and the British Geriatrics Society click here.

Creating a ‘Frail Friendly’ Acute Medical Unit (AMU) at George Eliot Hospital NHS Trust ….or what some specialities in my Trust used to call ‘not rocket science’…

Thinking about the latter part of this title, most of us that try to ‘practice’ geriatrics understand that it does sometimes feel like some form of mysterious dark art. A pinch of medicine, followed by a smidgeon of rehabilitation, mixed together with a drop of social care, a big dollop of communication and a dash of common sense. Simple? Not always…..

I’ve worked as a Physician Associate in Geriatrics for the last 7 years and have been fortunate over the last 12 months to have the opportunity to practice our ‘dark art’ in the new and exciting setting of AMU (well that’s what my Consultant said) and try to preach, sorry teach, the necessary skills to improve care for older people to those around me. I got a fancier title (I’m now an Acute Care of the Elderly Practitioner) and get to lead a lovely team of therapists, social worker and Age UK Navigator- they won’t thank me for the piccie but I like it. I was sat with a fabulous 98 year old gentleman at the other end of this photo and it made me smile- MDT at its best.

As healthcare professionals we understand that to improve hospital care for our most frail older people we need to try and ensure they are treated in the right bed (which might be their own), with the right plan for their care, for the right amount of time, with the right support for discharge. However, as those same healthcare professionals, we’ve also experienced the pressures in ED having to work on a ‘see, treat, move’ basis within a magical four-hour window.  We know the frailest in our society do not fit this model of care and that a system that relies on a one patient one problem approach is set up to fail these patients and ourselves.

This was the issue that as a department we wrangled with, how could we best serve our increasingly aging population with infinite enthusiasm but finite resources? It was agreed that as I was the one of our merry band with the most experience in delivering CGA throughout my current and previous roles and having been an apprentice sorcerer in the “trade” (coupled with the fact I’d been sent to ED for six months previously and survived) I was sent with my box of tricks to the world of acute medicine.

So what can those who work in acute medicine do? I decided if I need a good recipe for success I would look it up in a tried and tested cookbook.  This came in the form of the ‘Silver Book.’ I am very sad to say as I started on this journey of waving the geriatrics flag in the acute medical world I found that against this national ‘gold standard’ of care for older people as a Trust we were really not good (or as I described it to the Trust Board: an area for opportunity and improvement). With estimates that the number of people over the age of 85 is set to double in the UK during the next 20 years and those over 100 set to quadruple over the same period the statistics are frightening. Not only that but these statistics are people (our mums, dads, aunties, uncles and as I get on in years – me). Therefore we need to strive to deliver the holy grail of comprehensive geriatric assessment (CGA) to our frail and vulnerable patients to combine the key ingredients of the recipe to provide appropriate care and treatment.

Using the recipes and advice from the Silver Book we have established a dedicated Frailty Team embedded within the AMU to deliver CGA to frail older patients. We primarily see patients over 90 years of age, those from Residential and Nursing Homes and those patients with a diagnosis of dementia. We work alongside the acute medical team and with patients, families and carers to try to improve care, reduce length of stay and readmission rates for this group. So far so good in that we have reduced the average length of stay for these patients by more than half (around 4 days now) and halved readmission rates to around 10%. The team works from 8-5 Monday to Friday currently but we are looking to expand the team with additional therapists and a new PA for me to train in the dark arts to provide a 7 day service on AMU and work with the other wards as an outreach service. We have recently started a weekly MDT meeting with community matrons to discuss patients and try to roll out the CGA we use across the patch.

Challenging times lie ahead for health services throughout the world. Initiatives based on the Silver Book and utilising the skills and experiences of a wide range of healthcare professionals (such as shown at George Eliot Hospital) should be encouraged with efforts focused on getting things right for patients and a move to delivering safe and appropriate care as close to the patients home as possible (after all there is no place like home).

Membership of the BGS for physician associates in training is absolutely free and includes all the Society’s main member benefits. To join click here.

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