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Care of older people in hospitals is unacceptable, says think tank

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2352 (Published 27 March 2012) Cite this as: BMJ 2012;344:e2352
  1. Matthew Limb
  1. 1London

Older people’s care often breaks down in hospitals, and these failures in continuity of care are “unacceptable,” says the King’s Fund.

Jocelyn Cornwell, who led an analysis for the health policy think tank, said many frail, older people in hospitals with multiple conditions were being let down by poor communication from frontline staff, inadequate coordination, and poor planning.

She said one of the most glaring findings was how often patients were being moved around inside hospitals for non-clinical reasons.

Ms Cornwell called for radical improvements in practices and attitudes, including a “new definition of excellence in care and a realisation that quality depends entirely on relationships between patients and people who look after them.”

She said, “It is time to turn the rhetoric of personalised care into the reality of everyday care and practice.”

Ms Cornwell, who heads the King’s Fund’s point of care programme, co-authored Continuity of care for older patients: a call for action, one of two reports on older people’s care published by the King’s Fund on 27 March.

Continuity of care is especially important for older patients with multiple health problems because they are more likely than younger people to spend time in hospital and to be there for longer.

The report analysed older patients’ and carers’ experiences inside hospital between 2005 and 2010 using national inpatient survey data. In 2010, more than 66 000 patients responded to the national inpatient survey.

The King’s Fund found that measures of continuity of care had either remained static or had “slightly worsened” between 2005 and 2010.

It highlighted examples of unacceptable breakdowns in planning, communication, and coordination that caused frail older people to be passed around like “parcels” in hospital.

The report says that pressure to maintain high bed occupancy, reduce lengths of stay, and meet access targets in hospitals leads to patients being assigned the first free bed, often in the wrong ward, before being transferred again, sometimes late at night.

Ms Cornwell told the BMJ that many trusts did not audit such transfers, which should never take place out of hours for non-clinical reasons.

The report says that, for patients and carers, breakdowns in communication and in relations with frontline staff are the most distressing failures of continuity of care, which leave them feeling isolated and frustrated and often not involved in decisions that affect them.

In 2010, 22 % of patients said they could not find a member of staff to talk to about their worries and fears. Two-fifths of patients reported that their discharge was delayed. Both these proportions had risen over the 2005 figures.

The report says, “The scale of the problem and the number affected is unknown, but it is quite clear that a very great many older and very old patients are receiving sub-optimal care.”

The King’s Fund says relatively small changes in practice can significantly strengthen patients’ and carers’ relationships with clinicians and make clinical management more consistent.

The report says that staff need to “adapt and evolve our basic ways of working, including ward rounds, handovers, record-keeping, multidisciplinary working, and more.”

The King’s Fund says that a revolution is needed in the way older people experience care in hospital to deal with the “deep and systemic” issues that underlie many of the problems.

Hospital boards should ensure that a named professional is responsible and accountable for every patient and also that all staff receive training in the care of older people.

Ms Cornwell said, “Consultants have a responsibility to tell patients who is in charge of their care.”

A second King’s Fund report, summarising the findings from a summit held last year on care for older people with complex needs, makes five recommendations for improvements.

It includes a call for professional bodies to mount a concerted campaign to change professional attitudes through education and training and raise the status of caring for older people among the health workforce.

Notes

Cite this as: BMJ 2012;344:e2352

Footnotes