accident emergency, front door and discharge planning Flashcards
what was increased in frail individuals compared to non- frail individuals?
- mortality after 2 years was increased
what do patients in the ambulatory cohort classified as frail have an increase in? (2)
- increased mortality and hopsital use
what are the 4 processes of acute hospital front door admission?
- preadmission
- hospital attendance
- admission
- community
what are the three methods of preadmission?
- GP
- 111
- 999
what are the 2 types of hospital attendances?
- emergency department
- alternative admission area
what are the two types of admission?
- medical admission unit
- other subspeciality admission
how do you facilitate an expert assessment of the patient’s needs?
- connecting community services with specialist frailty secondary care advice facilitates an expert assessment
what is SDEC?
- same day emergency care services
what are the 2 ways that care is optimised pre- admission?
- community based interventions
- scheduled secondary care reviews
when is a sensible point of intervention for frail individuals and why?
- often conveyed to hospital by ambulance so it is a sensible point of intervention
- aims to avoid hospital attendances where possible
who is the pre-admission system run by?
- ran by a frailty team
who runs a frailty team?
- run by a geriatrician working on a frailty of SDEC unit or as part of a service providing frailty expertise to EDs
what do frailty services within the ED facilitate? what is this rather than?
- facilitate proactive rather than reactive patient reviews
what do frailty services within the ED prioritise?
- prioritise getting the right patient to the right team as quickly as possible
what do frailty services identify?
- identify those with complex needs that the ED cannot address
what do unwell patients with frailty often require?
- require more comprehensive and joined- up management
what is effective in terms of prioritising patients?
- prioritising patients who have recently been discharged from geriatric medicine wards or patients attending care homes can be effective
how are geriatric medicine ward patients or care home patients managed? what does this make more likely?
- managed by the FDF service
- more likely that admission can be avoided and prearranged social care can be maintained
what method is most used for initial scoping work of front door frailty services?
- in reach or liaison work
what do rapid reviews at ambulance arrival enable? what does it limit?
- enable early commencement of CGA to limit the risk of deconditioning from the point of arrival to the hospital and provide an increased opportunity to discharge without increasing care needs
what have many sites promoted?
- ACP
- advanced clinical practitioner
what is ACP alongside?
- alongside therapy teams to support the ED with the identification of patients can be managed in the community with simple interventions
what can ACP initiate?
- can initiate a CGA independently with close support from a geriatrician and enact a referral to community services
what have ACP teams developed?
- developed specific pathways for common conditions affecting older people with frailty
what are the three common conditions affecting older people with frailty?
- fracture
- loss of independent mobility
- falls with head injury
what do the pathways for common conditions of frail individuals enable?
- enables rapid structured assessment for potential community management
who else can in- reach teams review?
- can review patients deemed appropriate for admission and awaiting a bed to identify those who could be diverted to frailty units or SDEC instead
how do in- reach teams complement the work in the frailty unit?
- work as mobility assessment teams for more straightforward reviews
