When older people with dementia are admitted to hospital, they are more likely to die or to stay in hospital longer than people without dementia. Many older people have cognitive impairment (CI) (problems with memory and thinking) which is a main feature of dementia, but have not yet been given a diagnosis, or may have CI due to other medical conditions. We investigated how common cognitive impairment is in older patients in hospital, and what the risks are for these patients of staying longer or dying in hospital. Continue reading →
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
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.
Gillian Fox, Alison Cracknell, Sadia Ismail and Eileen Burns are all Consultants in Interface Geriatrics at Leeds Teaching Hospitals NHS Trust
Leeds Teaching Hospitals has a 60 bedded general adult medical admissions unit and a 60 bedded Elderly Admissions Unit with comprehensive geriatric assessment (CGA) embedded to either facilitate discharge to community services with ongoing assessment and/or rehabilitation where needed or begin treatment and investigation before transfer to an elderly care ward.
As part of the Leeds acute care model, 2012 saw the introduction of Interface Geriatricians (IGs). This service was developed with initial funding from the PCT (later CCGs) aiming to avoid admission where appropriate. We have developed a model for working for the IG that covers 3 key areas of interface – community, PCAL (primary care access line) and the emergency department (ED). Continue reading →
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. Continue reading →
It’s a Thursday morning in February, and I have just arrived on the ward to start my ward round. Mrs Y, a lady in her 90’s with dementia, was admitted with pneumonia a few days ago. She is on the mend, rehabilitating well, and we planned to get her home tomorrow with some extra home care. Now she is nowhere to be seen. Continue reading →