FRAIL AND ELDERLY
PATHWAY PROJECT
CROSSHOUSE HOSPITAL
NHS AYRSHIRE AND ARRAN
Dr Rowan Wallace (Consultant Geriatrician)
on behalf of the project team
OVERVIEW
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Background
Existing structure
Team members
Frailty index
Pathway model
Preliminary outcomes
Case studies
Summary
BACKGROUND
• ‘new consultant syndrome’
BACKGROUND
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Medical student elective project
Integrated Care and Enablement Service
‘Frailty project’
All people >65 years admitted to medicine over
10 days included. Followed up at 2 month and 6
months.
• Frailty index applied
• Aim to assess burden of frailty and whether
outcomes were related to frailty score
BACKGROUND
Results of frailty study
• 175 people admitted
• 75.4% patients had a score of >4
• Significant proportion were admitted to medical
specialties other than geriatrics and these were
more likely to be ‘boarded’
• Higher frailty meant longer length of stay
• Time to senior review up to 24 hours – and not
necessarily to commence GCA
EXISTING STRUCTURE
CROSSHOUSE HOSPITAL
XRAY
MEDICINE FOR THE ELDERLY
WARDS
ACUTE MEDICAL
RECEIVING WARD
ED
PHARMACY
EXISTING STRUCTURE
ATTENDANCE RATES
CONVERSION TO ADMISSION
EXISTING STRUCTURE
• 6 Consultant Geriatricians
• 70 ‘acute’ inpatient beds
• 8 allocated to Care of the Elderly daily – chosen
by criteria based on the BGS Silver Book
• IC&ES (Integrated Care and Enablement
Service) based in 3 community hubs
ICES MANAGER
EAST ICES(Joint Health & LA
managers )
Team Leader (Community &
Assessment Rehab Nurse) x 1.0 wte
NORTH ICES
Team Leader (Physiotherapist) x 1 wte
SOUTH ICES
Team Leader (Community &
Assessment Rehab Nurse) x 1.0 wte
Physiotherapy x 1.5 wte
Physiotherapy x 3.5 wte
Integrated Care Practitioner x 1.0wte
Occupational therapy x 3.5 wte
Physiotherapy x 3.5 wte
Occupational therapy x 3.3 wte
Comm Assess & Rehab Nurse x 2.0
wte
Community Assess & Rehab Nurse x
2.8 wte
Pharmacy x 1.0 wte
Pharmacy x 0.8 wte
Occupational therapy x 2.8 wte
Community Assessment & Rehab
Nurse x 2.0 wte
Dietitian x 0.5 wte
Dietitian x 0.5 wte
Pharmacy x 0.8 wte
Social Work Assistant x 1.0 wte
Dietitian x 0.5 wte
Care Manager x 1.0 wte
Technical Instructor x 2.47 wte
Technical Instructor x 3.0 wte
Homecare Manager x 2.0 wte
Falls Technical Instructor x 1.0wte
Support Assistant x 7.0 wte
Falls Technical Instructor x 1.0 wte
Administration x 3.5 wte
Technical Instructor x 2.07 wte
Falls Technical Instructor x 1wte
Rehabilitation Assistant x 4.0 wte
Administration x 5.3 wte
Carers x 27wte Response Team x
Income Maximiser x 1.0 wte
Carers are accessed from the local
authority Reablement service.
Administration x 3.35 wte
Carers x 4.48wte
EXISTING STRUCTURE
• 6 Consultant Geriatricians
• 70 ‘acute’ inpatient beds
• 8 allocated to Care of the Elderly daily – chosen
by criteria based on the BGS Silver Book
• IC&ES based in 3 community hubs
• Mental Health Liaison review by email referral
• Ward based pharmacy
AIMS OF PROJECT
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Early identification of frailty
Improve admission to senior medical review time
Improve admission to specialist GCA start time
Early identification of delirium
Improve service user and carer experience
Decrease unplanned admissions
Not adversely affect 4 hour wait times
TEAM MEMBERS
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Rowan Wallace, Consultant Geriatrician
Shauna Cathcart, Pathway Facilitator
Joan Pollock, East Ayrshire Social Work
Elizabeth Young, North Ayrshire Social Work
Stuart Gaw, ICES Manager
ICES Specialist Geriatric Nurses – Evelyn Boyle and Yvonne Deans
Stephanie Staines, Deputy Charge Nurse ED
Mary Ann McEwen, A&E Mental Health Liaison, Older People
Toni Fernandez, Community Wards GP
Julie Mardon, ED Consultant
Rebekah Wilson, Occupational Therapy Team Lead (Representing AHP)
Dale McLelland, Development Manager, Older People Services
Karen Mathie, Service Improvement Facilitator
Ashley Strannigan, Charge Nurse CDU
Lesley Herd, Pharmacist
Admin – Lynn Kirkland and Annegela Schaffield
ANP – Donna Lundie
Charge nurses from Care of the Elderly wards – Maureen Fleming and Lynn McLaughlin
FRAILTY INDEX
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Many are available
Most are overly complex
Simple design
Based on Comprehensive Geriatric
Assessment
FRAILTY INDEX
>65 years age with 1 or more of below
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Residential or nursing home resident
New acute confusion (delirium)
Impaired mobility or other functional impairment
Fall in past month
Dementia (4AT)
Incontinence
Care Package
MEWS>3
MENTAL HEALTH SCREENING TOOL
PHARMACY INFORMATION