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CROSSHOUSE HOSPITAL NHS AYRSHIRE AND ARRAN Dr Rowan Wallace (Consultant Geriatrician) on behalf of the project team. FRAIL AND ELDERLY PATHWAY PROJECT. Background Existing structure Team members Frailty index Pathway model Preliminary outcomes Case studies Summary. OVERVIEW. - PowerPoint PPT Presentation
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FRAIL AND ELDERLY PATHWAY PROJECT
CROSSHOUSE HOSPITAL
NHS AYRSHIRE AND ARRANDr 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
ED
MEDICINE FOR THE ELDERLY WARDS
ACUTE MEDICAL RECEIVING WARD
PHARMACY
XRAY
CROSSHOUSE HOSPITAL
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 )
NORTH ICES SOUTH ICES
Team Leader (Community & Assessment Rehab Nurse) x 1.0 wte
Physiotherapy x 3.5 wte
Occupational therapy x 3.3 wte
Comm Assess & Rehab Nurse x 2.0 wte
Pharmacy x 0.8 wte
Dietitian x 0.5 wte
Care Manager x 1.0 wte
Homecare Manager x 2.0 wte
Support Assistant x 7.0 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 30wte
Team Leader (Physiotherapist) x 1 wte
Physiotherapy x 1.5 wte
Occupational therapy x 3.5 wte
Community Assess & Rehab Nurse x 2.8 wte
Pharmacy x 1.0 wte
Dietitian x 0.5 wte
Social Work Assistant x 1.0 wte
Technical Instructor x 2.47 wte
Falls Technical Instructor x 1.0wte
Administration x 3.5 wte
Carers are accessed from the local authority Reablement service.
Team Leader (Community & Assessment Rehab Nurse) x 1.0 wte
Integrated Care Practitioner x 1.0wte
Physiotherapy x 3.5 wte
Occupational therapy x 2.8 wte
Community Assessment & Rehab Nurse x 2.0 wte
Pharmacy x 0.8 wte
Dietitian x 0.5 wte
Technical Instructor x 3.0 wte
Falls Technical Instructor x 1.0 wte
Income Maximiser x 1.0 wte
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