The BMJ Awards 2019: Care of the Older Person Team of the YearBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l989 (Published 05 March 2019) Cite this as: BMJ 2019;364:l989
- Jacqui Wise, freelance journalist
- London, UK
Acute frailty pathway
The biggest growth in unplanned care and emergency department attendance is in older people living with frailty. The Royal Surrey County Hospital NHS Foundation Trust found that frail over 75 year olds were poorly identified and likely to breach the four hour waiting time targets.
In order to tackle the problem, the hospital instituted a “big room” approach adapted from the Toyota production system, says James Adams, consultant geriatrician and clinical lead for the project. Once a week there is an open invitation for doctors, therapists, nurses, and healthcare assistants to meet with a data analyst and use quality improvement methodology to pick apart the problems and work out solutions.
“The result has been a cultural change. We now have identification of frailty as soon as a patient comes into the emergency department. We then have a multidisciplinary team that deliver a comprehensive geriatric assessment,” says Adams.
The project has reduced the time frail elderly patients spend in the emergency department by 19%—down from 4.4 hours to 3.6 hours. Same day and next day discharges from the emergency floor have also increased. The overall median length of hospital stay was reduced by 24%, from an average of four to three days, and the mean length of stay was reduced by 14%, from an average of nine to seven days.
UTIs in the elderly
Public Health England does not recommend using urine dipsticks to diagnose urinary tract infections (UTIs) in the elderly because, in this age group, there is a certain amount of bacteria present in the urine even if there is no infection. In practice, however, dipsticks …