The right intervention, at the right time, in the right place…

Stephanie Robinson is an occupational therapist at Harrogate hospital working as the  frailty team leader across the medical elderly wards and previously seconded into the Supported Discharge Service. She has had a key role in cross boundary working, outreaching from frail elderly inpatient based wards to the community.

The right intervention, at the right time, in the right place… How Harrogate District Foundation Trust therapists from the community and in-patient wards are tackling the national bed crisis: piloting a Supported Discharge Service.

The pressure is on in Harrogate – the population of over 60s is 26.5% compared to 22.4% nationally.  By 2030 the district’s over 65 population is predicted to increase by 15,000 people.  One of the Trust’s strategic aims for the next five years is to integrate acute, community and social care to allow patients to be treated closer to home, or at home and reduce reliance on acute beds.  It is understood that therapy assessments completed in a patient’s own home are a more accurate reflection of their capabilities than those completed in the hospital environment.  Based on the Discharge to Assess model, the concept that the hospital is often not the most appropriate place for patients of any age to remain is not a new one.

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.

Innovating the Delivery of Care for Older People – My Thoughts

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

Another Monday morning at work, and I was looking forward to another week of inspiration with my fantastic boss in interface geriatrics as part of my hospital’s OPAL (Older Peoples’ Assessment & Liaison) team and in our Older Peoples Rapid Access Clinic. Before I got going, I undertook a cursory check of my e-mails and I saw something slightly out of the ordinary – an e-mail from Professor David Oliver (of British-Geriatrics-Society-President-elect fame). “What are you doing Wednesday?” he asks. “Come to my conference at The King’s Fund!” he beckons. My consultant’s response when I asked her permission was “You’d better have already said yes!”. Off I went.

Making Health and Care Fit for an Ageing Population.

Kings Fund and BGS Conference: BGS President Elect, David Oliver, describes how this conference ties in to the work of the BGS and the Department of Health’s new proposals to improve care for vulnerable older people.

On 22 October, the Kings Fund is hosting a one day event on making health and care services fit for an ageing population. This event is supported by the BGS and several of our members are speaking. I am fortunate to have a foot in both camps as BGS president-elect but also as a Kings Fund Visiting Fellow. We have timed the event to coincide with the planned autumn announcement by Rt Hon Jeremy Hunt MP – Secretary of State for Health – of the Vulnerable Older Peoples Plan. Mr Hunt is due to speak at our event and announce some further details.

Geriatric discharges from a hell: A patient experience story.

Ron Murphy is a software designer, he blogs at ronmurp.net 

Discharging frail older patients can be complicated and requires multi-disciplinary input and co-ordination between doctors, nurses, therapists, pharmacists and social workers – not to mention the patient and their family. When it goes wrong, it can turn a positive patient experience into a harrowing story of failure and incompetency, Ron Murphy whose, mum was recently admitted to hospital, recounts some episodes of hospital discharges going amiss. Not for the faint-hearted.

The traditional Multidisciplinary Meeting: Still the Gold Standard or Losing its Lustre?

Prof David Oliver is a Consultant Geriatrician in Berkshire and a visiting Professor in Medicine of Older People at City University, London. He is President Elect of the British Geriatrics Society.

Since leaving my role as national clinical director at the end of last year, I have found myself seconded for day a week to the NHS Emergency Care Support Team and to the Kings Fund alongside my clinical day job. In this new capacity, I have gone into a number of busy acute hospitals or health economies to review care pathways for older people. It has been fascinating to meet so many hard-working colleagues and to see the similarities and differences in how older people’s services are delivered. A key focus in these visits is ensuring that – whatever the issues may be with external delays waiting for “step down” community services or social care – we do, as hospital teams whatever we can internally to minimise delays in our own care pathways.