Rowan Wallace OPAC session 31 May part 1

FRAIL AND ELDERLY PATHWAY PROJECT CROSSHOUSE HOSPITAL NHS AYRSHIRE AND ARRAN Dr Rowan Wallace (Consultant Geriatrician) on behalf of the project team

OVERVIEW • • • • • • • •

Background Existing structure Team members Frailty index Pathway model Preliminary outcomes Case studies Summary

BACKGROUND • ‘new consultant syndrome’

BACKGROUND • • • •

Medical student elective project Integrated Care and Enablement Service ‘Frailty project’ All people >65 years admitted to medicine over 10 days included. Followed up at 2 month and 6 months. • Frailty index applied • Aim to assess burden of frailty and whether outcomes were related to frailty score

BACKGROUND Results of frailty study • 175 people admitted • 75.4% patients had a score of >4 • Significant proportion were admitted to medical specialties other than geriatrics and these were more likely to be ‘boarded’ • Higher frailty meant longer length of stay • Time to senior review up to 24 hours – and not necessarily to commence GCA

EXISTING STRUCTURE CROSSHOUSE HOSPITAL

XRAY

MEDICINE FOR THE ELDERLY WARDS ACUTE MEDICAL RECEIVING WARD

ED

PHARMACY

EXISTING STRUCTURE

ATTENDANCE RATES

CONVERSION TO ADMISSION

EXISTING STRUCTURE • 6 Consultant Geriatricians • 70 ‘acute’ inpatient beds • 8 allocated to Care of the Elderly daily – chosen by criteria based on the BGS Silver Book • IC&ES (Integrated Care and Enablement Service) based in 3 community hubs

ICES MANAGER

EAST ICES(Joint Health & LA managers ) Team Leader (Community & Assessment Rehab Nurse) x 1.0 wte

NORTH ICES Team Leader (Physiotherapist) x 1 wte

SOUTH ICES Team Leader (Community & Assessment Rehab Nurse) x 1.0 wte

Physiotherapy x 1.5 wte Physiotherapy x 3.5 wte

Integrated Care Practitioner x 1.0wte Occupational therapy x 3.5 wte Physiotherapy x 3.5 wte

Occupational therapy x 3.3 wte Comm Assess & Rehab Nurse x 2.0 wte

Community Assess & Rehab Nurse x 2.8 wte Pharmacy x 1.0 wte

Pharmacy x 0.8 wte

Occupational therapy x 2.8 wte Community Assessment & Rehab Nurse x 2.0 wte

Dietitian x 0.5 wte Dietitian x 0.5 wte

Pharmacy x 0.8 wte Social Work Assistant x 1.0 wte Dietitian x 0.5 wte

Care Manager x 1.0 wte Technical Instructor x 2.47 wte

Technical Instructor x 3.0 wte

Homecare Manager x 2.0 wte

Falls Technical Instructor x 1.0wte Support Assistant x 7.0 wte

Falls Technical Instructor x 1.0 wte Administration x 3.5 wte

Technical Instructor x 2.07 wte Falls Technical Instructor x 1wte Rehabilitation Assistant x 4.0 wte Administration x 5.3 wte Carers x 27wte Response Team x

Income Maximiser x 1.0 wte Carers are accessed from the local authority Reablement service.

Administration x 3.35 wte Carers x 4.48wte

EXISTING STRUCTURE • 6 Consultant Geriatricians • 70 ‘acute’ inpatient beds • 8 allocated to Care of the Elderly daily – chosen by criteria based on the BGS Silver Book • IC&ES based in 3 community hubs • Mental Health Liaison review by email referral • Ward based pharmacy

AIMS OF PROJECT • • • • • • •

Early identification of frailty Improve admission to senior medical review time Improve admission to specialist GCA start time Early identification of delirium Improve service user and carer experience Decrease unplanned admissions Not adversely affect 4 hour wait times

TEAM MEMBERS • • • • • • • • • • • • • • • • • •

Rowan Wallace, Consultant Geriatrician Shauna Cathcart, Pathway Facilitator Joan Pollock, East Ayrshire Social Work Elizabeth Young, North Ayrshire Social Work Stuart Gaw, ICES Manager ICES Specialist Geriatric Nurses – Evelyn Boyle and Yvonne Deans Stephanie Staines, Deputy Charge Nurse ED Mary Ann McEwen, A&E Mental Health Liaison, Older People Toni Fernandez, Community Wards GP Julie Mardon, ED Consultant Rebekah Wilson, Occupational Therapy Team Lead (Representing AHP) Dale McLelland, Development Manager, Older People Services Karen Mathie, Service Improvement Facilitator Ashley Strannigan, Charge Nurse CDU Lesley Herd, Pharmacist Admin – Lynn Kirkland and Annegela Schaffield ANP – Donna Lundie Charge nurses from Care of the Elderly wards – Maureen Fleming and Lynn McLaughlin

FRAILTY INDEX • • • •

Many are available Most are overly complex Simple design Based on Comprehensive Geriatric Assessment

FRAILTY INDEX >65 years age with 1 or more of below

• • • • • • • •

Residential or nursing home resident New acute confusion (delirium) Impaired mobility or other functional impairment Fall in past month Dementia (4AT) Incontinence Care Package MEWS>3

MENTAL HEALTH SCREENING TOOL

PHARMACY INFORMATION