Paramedics; Frailty detection and admission avoidance

Dr Amy Heskett works as a Speciality Doctor within the West Kent Urgent Care Home Treatment Service. This team aims to prevent hospital admissions by working alongside GPs, nurses, carers and paramedics to provide a holistic management plan. She writes a blog about her experiences on her blog communitydoctoramy.wordpress.com and can be found on twitter @mrsapea

paramedics-photoThe West Kent Home Treatment Service provides home-based medical treatments to avoid hospital admissions when appropriate. Referrals come from GPs, Community Nurses and Paramedics; but more importantly our team widens as soon as we start to work with patients, their family and carers.

A day of referrals began with a call from a Paramedic who had attended V after she had fallen in her bedroom, but luckily sustained no injury. This was on a background of dementia and the need for daily support from her son to assist with meals, prompt medications and support trips made outside the home. V’s only other medical history was that of hypertension and one fall a year ago. V was normally able to get herself to the toilet and used a stick to mobilise slowly indoors; while carers attended once a day to provide personal care. Continue reading

Hospital at Home Forum at the BGS Autumn Meeting

Dr Graham Ellis is an Associate Medical Director and Older Peoples Services Consultant Geriatrician for NHS Lanarkshire. He is also one of the key speakers at the Hospital at Home UK Forum at the BGS Autumn Meeting on Wednesday 23rd November in Glasgow. 

home-heartOlder people are presenting to acute hospitals in greater numbers year on year. Predictions of the future demographic raise serious questions about the sustainability of hospital based services. The Future Hospitals Commission recommended the development of specialist hospital services in the community delivering new and innovative services closer to the point of need.

Older people’s services in particular are challenged to meet existing and predicted demand. Recent headlines have highlighted inadequate alternatives to admission for older people. Yet older people should receive high quality, safe and effective care best suited to their needs that includes Comprehensive Geriatric Assessment.  Continue reading

Reducing hospital admissions: a new integrated model for care homes

Sally Roberts is Lead Nurse (Quality and Partnerships) at Walsall Clinical Commissioning Group. Here she describes work undertaken jointly by Walsall CCG and Walsall Healthcare NHS Trust, which has led to the implementation of a new integrated health care model within care homes.

Walsall’s new model of care has enabled the whole care home sector to raise standards, measurably improve outcomes for residents in care homes and reduce unnecessary hospital admissions.

Our work commenced in earnest with the nursing home sector over three years ago, at a time when there was increasing suspension of admissions, often due to poor quality and patient safety issues; these reduced market capacity and choice for people, and created financial uncertainty for some smaller independent homes. Care home managers reported in several forum meetings that they were struggling with poor staff retention, disrupting stability of care, leading to ineffective planning and viability of the home in the long term. In addition, the lack of proactive management of patients resulted in a high number of avoidable hospital admissions.

Continue reading

A Naïve Junior Doctor’s Opinion on “Admission Avoidance”

Daniel Sommer is a Foundation Year 2 Doctor at Charing Cross Hospital in London. He is an aspiring Geriatrician. He tweets at @danielf90 shutterstock_115739950

Hello everyone, my name is Dan and I’m a junior doctor and an aspiring geriatrician (read my last blog post here). My new job is working as part of my hospital’s OPAL (Older Peoples’ Assessment & Liaison) team and I absolutely love it. We run a rapid access day clinic that GPs refer into and we review every patient over the age of 70 who is on the acute medicine unit routinely (usually after the consultant post-take ward round but sometimes we’re asked to intervene earlier). I felt compelled to write something about admission avoidance in the elderly because I hear so much about it in the media and my working experience does not correlate with what I read. Continue reading

Do pharmacists have a role in reducing emergency admissions?

Alyson Huntley is a Research Fellow at the University of Bristol’s Centre of Academic Primary Care. She has recently published a systematic review of pharmacist-led interventions to reduce unplanned admissions for older people.EmergencyAvoidance

The expansion of the pharmacist’s role as a contributor to patient’s health has been championed over the last couple of decades.  In addition to their traditional role, pharmacists contribute to the care of people with long term conditions by carrying out medication reviews, promoting healthy lifestyles, and supporting self-care.

The older people become, the more medications they are likely to be taking (both prescribed drugs and self-medication) leading to an increased risk of adverse reactions, interaction between drugs and poor adherence. Continue reading

Award Winning Telehealth

Chief Executive of Airedale NHS Foundation Trust; Bridget Fletcher discusses how this Yorkshire Hospital is delivering unique, new and bespoke video consultation services to support patients in their own home and preventing unnecessary admissions to ED and inpatient beds.telehealth

Overburdened A&E departments and hospital wards full to capacity are almost daily news items currently.  It is likely that the individual human stories behind those news items involve very many people over the age of 65 living with one or more long term conditions.  In fact statisticians tell us around 70% of our NHS resources in general are spent caring for patients living with long term conditions, much of which is re-active care rather than proactive. Continue reading