Analysis

Process for older people attending urgent care services streamlined

Faster access to specialist care for frail older patients at a Kent emergency department (ED) has cut how long they spend in hospital

Faster access to specialist care for frail older patients at a Kent emergency department (ED) has cut how long they spend in hospital.

A specialist nurse and geriatric consultant see patients as soon as possible after they arrive at the ED or medical assessment unit at Medway Maritime Hospital, which is part of Medway NHS Foundation Trust, Kent.

The acute frailty service, which was launched last March, is designed for older patients to receive appropriate care swiftly by being admitted or sent home promptly. In the past, such patients had to be admitted before they could see specialist staff.

Comprehensive assessment

Frailty nurse specialist Maisey Davis says treatment and discharge planning now starts as soon as the patient is seen by specialist ED staff. ‘They get a comprehensive geriatric assessment, and it is decided what treatment they need and whether to admit them and for how long.’

EDs are often not the best place for frail people, especially those with dementia, Ms Davis says. ‘If people are seen quickly in the emergency department, we can move them swiftly to the older people’s care ward or the dementia unit, which are more appropriate places. It is leading to reductions in the amount of time spent in hospital.’

Patients are reviewed and followed by the team throughout their stay, Ms Davis says. Many who will be seen by the service are over 80 years of age, live in nursing or residential homes, and have dementia, delirium and a history of falls.

Reduced length of stay

The service runs from 8am to 5pm, Monday to Friday. Ms Davis says that, during its initial six-week pilot, the length of stay for frail patients was reduced by eight days.

Consultant geriatrician Sanjay Suman says the project is particularly important given the poor report into Medway NHS Foundation Trust by the Care Quality Commission (CQC) last month. The report rates the trust as inadequate and states that the ED could not meet demand, with patients left waiting on trolleys in corridors without sufficient checks from staff.

‘In light of the CQC’s report, it is imperative that we continue to deliver projects of this nature to ensure our older patients are seen by an integrated team of medical professionals, rather than multiple doctors,’ he says. ‘This will get patients the right type of treatment and improve their overall experience.’

Enhanced care

Nurse practitioner and senior lecturer in emergency care at the University of Wolverhampton Jim Bethel agrees that such services enhance care.

‘Older patients make up almost as big a proportion of workload as children, yet specialist services for them are lacking and advocates for them are not as voluble as advocates for children,’ he says.

‘This kind of approach is becoming a little more widespread, and means that the care experienced in EDs by older people, and their families and carers, will be much improved.’

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