Elderly patients avoid unnecessary hospital stay thanks to pilot QEUH initiative

By Lucy Ashton

A pilot initiative from NHSGGC has doubled the number of elderly patients able get back to their homes on the same day of admission to hospital.

The Frailty at the Front Door team which specialises in delivering person centred treatment to elderly patients, used a new approach to help increase same day discharge from 15% up to 30% from those patients presenting to A&E.

By scrutinising common challenges experienced within unscheduled care, the team were able to identify areas where rapid change could be implemented to speed up discharge and minimise the time patients had to spend in hospital. Key to this was ensuring frailty specialists were involved in patient care as early as possible at the ‘front door’.

A dedicated advanced nurse practitioner was based in A&E to review patient admissions over a week, helping identify when frailty specialists could offer advice and early interventions, and as a result, there were significant improvements in the patient journey as the specialist team was involved in care quicker than usual. In total, more than 122 patients were seen and assessed over the trial period.

In addition to enhanced collaboration between A&E and Frailty, the pilot encouraged pharmacy and HSCP input into care early on, resulting in a more efficient delivery of care both in an acute setting and back in the community. 

One patient described the treatment as ‘a ribbon that flowed perfectly, when I needed something it was there’ after having undergone a full geriatric assessment by a geriatrician alongside the multidisciplinary frailty team at the same time, which allowed them to address multiple concerns at once, therefore allowing the patient to be discharged in four hours instead of potentially over 24 hours.

Stuart Gaw, General Manager for Older People’s Services said: “No one wants to be in hospital any longer than they need to be, and this is perhaps even more important for our older patients.

“Our pilot showed that with some tweaks to the way we deliver care at the front door, and taking a multi-disciplinary approach as early as possible, that we were able to ensure our patients got the right type of specialist care as quickly as possible, in turn leading to more same day discharges and patients returning to their homes.

“Although the initiative was part of our Quality Improvement pilot programme, a number of key learnings have already been implemented on the ground to help speed up discharge where appropriate. We are also reviewing resources with a view to implementing the pilot on a more long-term basis at the QEUH.”

Morag Gardner, Chief Nurse for the South sector, including the QEUH, added: “The pandemic has shone a light on how effective cross-service approaches can be when teams work together. The Frailty at the Front door team pilot is a key example of this in action and showed that even smaller changes to the way teams communicate with each other, can have a significant positive impact on patient care.

“We continually encourage our staff to adopt a quality improvement approach to work which helps us continue to innovate, and enhance the quality of care we provide to our patients on a daily basis.”

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