Using a frailty index in the Emergency Department

Dr Audrey-Anne Brousseau is the first fellow in geriatric emergency medicine in Canada. She was recently appointed as assistant professor at the Université de Sherbrooke in Quebec. Her work focuses on developing best practices for older adults in the emergency department.

EDs are often the safety net of the health care system where the mission is to (rapidly) evaluate, intervene and organize transitions of care. With the aging of the population and the growing presence of older adults in EDs, this mission represents a significant challenge because older adults are complex on multiple levels.

How do we determine whether a patient is fit to go back home — or not?  Needs admission —  or not? Would benefit from rehabilitation, additional community services, further assessment — or not?  A comprehensive geriatric assessment will provide this answer, but is rarely readily available in most EDs. Moreover, human and material resources are often limited in public health care system preventing all older adults ED patients to get a geriatric assessment and appropriate interventions. Continue reading

Frailsafe is growing…

Zoe Wyrko is a Consultant physician at University Hospital Birmingham and is the Director of Workforce for the BGS. She tweets at @geri_babyfrailSafeLogo

Sometimes, when you are closely involved with something it can be hard to see how far you have come until you stop and take a look back. In February I wrote about how the checklist to improve the care of older people living with frailty had developed from a ‘good idea’ into a multi-organisational collaborative project funded by a Health Foundation grant. Tom Downes has also previously blogged about the project.

Pilot sites have been selected, agreements signed, and multidisciplinary teams chosen within hospitals to take the work forward. Continue reading

Keeping or increasing function in frail older people after a hospital admission  

Hugh Senior is an epidemiologist at the University of Queensland, Australia, and Matthew Parsons is a gerontologist at the University of Auckland, New Zealand. Their paper Promoting independence in frail older people: a randomised controlled trial of a restorative care service in New Zealand has recently been published in Age and Ageing journal.function in frail older people

Many older people will experience a decline in their level of physical function during the period of developing an acute illness that requires hospitalisation and discharge from hospital. A third will be discharged from hospital having not recovered the level of function that they had prior to becoming unwell. The loss of physical function includes losses in key areas required for independent living such as dressing, bathing, getting out of bed or a chair, toileting, eating and walking across a room. As such, this has an impact on the older person’s ability to live independently and safely at home, and increases both the likelihood that the older person will need to reside at a residential care facility and the likelihood of death. A possible intervention to help older people with hospital associated disability is to provide restorative rehabilitation after discharge from hospital, for those who may benefit, with an aim to return to a level of independence where they can return to their own home. 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

Overnight Hospital Discharges

Chris Roseveare is a Consultant Physician in Acute Medicine at University Hospitals Southamption, and is Editor of Acute Medicine Journal. He tweets at @CRoseveare. Here he discusses a recent report from Sky News: Hundreds Discharged From Hospitals Every Night

nighttime discharges

It’s 2am on a Sunday in a hospital in the UK, and the duty consultant physician has just been called in. It has been a difficult weekend for the medical team: the Acute Medical Unit (AMU) was already full on Saturday morning following a busy Friday night. Compounding this, the locum agency were unable to fill the SHO vacancy on Saturday and the foundation year 1 called in sick for her night shift. Sunday had started with 15 medical patients waiting to be clerked in the Emergency Department (ED), and the medical team have struggled all day to clear the backlog. Ambulance trolleys are now queued in the corridor in the ED; there are ten patients who have waited more than four hours for a bed in the AMU, two of whom are approaching a twelve hour wait. Beds have been opened – and filled – in the managed care unit as well as the medical ambulatory care area. More than 20 patients have been ‘outlied’ into the surgical division during the course of the weekend, which has necessitated cancellation of a number of elective surgical admissions planned for surgery tomorrow. There no longer seems to be any room for manoeuvre.

In consultation with the on-call executive, the duty manager now has a plan: several patients have been identified across the hospital whose discharge is planned for Monday morning – perhaps if they could be discharged from hospital overnight this could help ease the pressure in the ED….? The medical consultant is on her way into the hospital. This will be a difficult discussion.

A recent report on Sky News suggested that ‘over 300,000 patients’ had been discharged from hospital overnight since 2012, including over 60,000 who were over 75. 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

BBC documentary series ‘Protecting our Parents’

Protecting Our Parents

Dr Peter Wallis, formerly consultant geriatrician – Birmingham Heartlands Hospital, was involved with the filming of a new BBC 2 Documentary Series

The department of elderly medicine at Birmingham Heartlands Hospital became aware of the BBC‘s interest in a documentary series about the care of older people following an advertisement in the British Geriatrics Society Newsletter (2012) placed by the BBC Bristol Documentary team.   The intention was to produce a 3 part documentary series reflecting current issues in the health and social care of older people. Following successful discussions and with the agreement of partner organisations including social services as well as primary, community, mental health and ambulance service teams, filming took place during 2012/13. Filming was centred around the elderly care and general wards as well as the A&E department at Birmingham Heartlands Hospital and the patients with their stories were followed into community settings.

Continue reading

Calling all geriatricians… FRAILsafe needs you!!

Zoe Wyrko is pleased to announce the next phase of FRAILsafe, a new checklist for the acute care of frail older people.your country needs you

Would you like to be involved in a national project which will change the way care is delivered to all frail older people, not just those who are able to be looked after by geriatricians on our specialist wards? Would you like to be part of work that will lead to improvements in the skills of all healthcare professionals who encounter vulnerable people in hospital? Would you like to see a reduction in the inadvertent harm caused when a frail older person needs to be admitted to hospital? If so …. read on. Continue reading

Working with GPs and Care Home staff to reduce emergency hospital admissions

The poster by R Lisk, K Yeong, A Nasim, B Mandal, R Nari, Z Dhakam can be found at the BGS Conference in the exhibition space at stand number 76.shutterstock_45287182

Residents of Care Homes with Nursing tend to be frail, have multiple diagnoses and high levels of dependency.  This results in complex care needs. Many experience multiple admissions to hospital, often with long lengths of stay.

This initiative was aimed at reducing the number of emergency admissions to our Trust from local Care Homes with Nursing, by working in partnership with staff in the homes and local GPs.  The aim was to help provide more bespoke care for this vulnerable patient group, keeping them out of hospital whenever it was possible and appropriate to do so.  The project was also part of a Trust-wide response to the new emergency admission cap introduced through the National Operating Framework 2010/11. Continue reading

Strategic planning in Intermediate Care is needed to “unstick” the NHS

Prof John Young is a Consultant Geriatrician in Bradford, UK and National Clinical Director for Integration and Frail Elderly at NHS England. Here he reflects on the 2013 National Audit of Intermediate Care. The full audit report can be found here.logo

I have been closely involved with the National Audit of Intermediate Care since its inception in 2008. The journey has been challenging but highly rewarding. The audit now covers about half the NHS – remarkable when you consider the commitment required by local staff to collect and submit the data.

The audit is important because it describes services that are otherwise relatively hidden from view in our conventional perception of health and social care. Yet intermediate care, or “care closer to home,” has been quietly developing during the last ten years or so. The focus has always been that of older people with co-morbidities/frailty – just the group that is now so much in the forefront of health and social care thinking. And intermediate care services have always been a platform to develop new ways of working – particularly multi-agency working – and so it is highly relevant to our current interest in service integration. Continue reading