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