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High Impact Change Area D: Timely identification and assessment in hospital – case studies
These case studies relate to High Impact Change Area D of the High Impact Change Model: Improving the timely and effective discharge of people with dementia and delirium into the community.
D1: St James’s University Hospital Leeds: ‘Interface geriatricians’
Plan
‘Interface geriatricians’ were established within the Emergency Department (ED), to assess older people with frailty, as well as working within the community, embedded within the integrated neighborhood teams.
Implementation
The ED service focuses on patients presenting to the Majors Department with common presentations such as falls, urine or chest infections, delirium, cellulitis and heart failure. The Early Discharge Assessment Team (EDAT) and the consultant geriatrician work together to provide a medical assessment for the patient, as well as establishing their function and any risks to discharge home. Part of this assessment involves understanding the patient's expectations and wishes, as well as involvement of family members. If deemed safe for discharge, patients can receive support within the community including aids and simple adaptations, or a night sitter may be approved.
To enhance communication, the Leeds Care Record is used to share vital information about the patient, therefore allowing secondary care to view patients’ usual medications, allergies etc. To relay management plans to community colleagues, either telephone or written communication is used. Follow-up can also be arranged, and in complex cases this may require the community geriatrician to work with primary care and continue the Comprehensive Geriatric Assessment (CGA) within the patient's home.
Outcome
For those aged 75 and above who attended the ED ‘majors’ stream:
- The convergence rate for attendance to admission fell from 74 per cent to 39 per cent when a geriatrician was within the department.
- 27 per cent were admitted due to an acute medical reason.
- 12 per cent were admitted due to a lack of capacity in the community bed base.
The readmission rate after discharge from ED was similar to that for the Medicine of the Elderly department’s overall rate. Feedback from primary care has been extremely positive. Patients and their families have expressed satisfaction with the care.
Further information: Integrated care for older people with frailty (BGS, RCGP 2016)