Highcliffe Average size practice c10,000 patients 6 partners, 3 salaried
Highcliffe Highcliffe Prevalence (%) National Prevalence (%) Cancer CHD HF Dementia Stroke HT DM6.75.8
Highcliffe Particular stresses Home visits NH Drug Budget And yet: Admission rates low Prescribing rates low Staff retention good
Meeting the Challenge in Hospital Hospitals and medical specialities emerged in an era when many people died in childhood or midlife of single diseases. In 2012, the main activity of general hospitals is the care of (generally older) people with (multiple) long-term conditions.
The challenge.. Frailty Safe Discharges Readmissions Comprehensive Geriatric Assessment
Frailty: Complexity + Poor Reserve A state of reduced homeostasis & resistance to stress that leads to increased vulnerability & risk to adverse outcomes such as disease progression, falls, disability & premature death Non-specific decompensation: Acopia
CGA PainDelirium and Dementia DepressionNutrition and Hydration Skin IntegritySensory Loss Falls and MobilityADLs ContinenceVital Signs Safeguarding IssuesEnd of Life Care Issues
Safe Discharges: CGA + Community services: –IC, GP, DN, LTC, CM Care providers: –family, care agency, RH / NH, SW, 3 rd Sector
Readmissions The new geriatric giant?
Models of Acute Care: Resources RCP Acute Care Toolkit 3: Acute medical Care for Frail Older People Quality Care for Older People with Urgent and Emergency Care Needs: Silver Book Both support application of CGA within an integrated system.
Local Model: Poole
Problems Generic MAU not leading to CGA LOS > national average Necessity: Ward closures triggered by £10m overspend
Aims CGA: –Senior clinical review and initiation of treatment –Early MDT assessment Facilitate discharge Reduce non DME outliers (to close beds safely) Manage emergency activity
Ethos of unit Senior triage of admission calls –Present alternatives Early senior assessment –Medical, Nursing, Therapy Prioritised diagnostics support Early Discharge planning Daily MDTM Support from SS to keep POC open Support from IC (Care, Clinical)
Length of stay data
Occupied bed days
Limitations / threats Changing relationship with providers Gaps in service –Lack of Step-Down beds –Non-commissioned services –Local EMI NH provision Ongoing CIP White Paper…
Summary Ageing population Integrated Systems to deliver CGA, facilitate safe discharge Some successes, some Threats