[Type text]
Contact the service on 07714456279
Acute Geriatric Intervention Service (AGIS)
This short guide provides an overview to the Acute Geriatric Intervention
Service (AGIS).
1. What is the Acute Geriatric Intervention Service)
The Acute Geriatric Intervention Service is a collaboration between Cambridge
Community Services and the East of England Ambulance Service. It is a
multidisciplinary team of ambulance clinicians, physiotherapy, occupational therapy
and a consultant geriatrician.
2. What does the service do?
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It is able to access social care input via reablement and nursing skills from the
local community services.
The aim of the service is to avert inappropriate hospital admission for elderly
patients who are in or at risk of imminent crisis which would likely result in an
acute admission.
The service will respond to 999 calls to the elderly and will accept direct
referrals from GP’s against set criteria. The team will look to provide a
comprehensive geriatric assessment which is holistic and patient centred. This
can include the patient’s physical health, functional ability, cognitive function,
nutritional status, mobility and falls, and an environmental assessment.
The service has the ability to provide multiple interventions at the time of
contact such as functional equipment and walking aids, wound care and
provision of some medications.
It can make appropriate onwards referral, be that for further assessment such
as Consultant Community Geriatrician, specialist nursing, community matrons,
RADAR or START, the implementation of care packages and use of respite
beds or on-going rehabilitation such as balance and strength classes or
community therapy and referral onto other service such as care lines or
assistive technology.
Where it is appropriate for a patient to be transported to an acute facility, an
access visit report is provided alongside the medical assessment with any
relevant information to assist the hospital staff in ensuring a timely discharge.
As well as having a responsive element to the Consultant Geriatricians input,
the consultant will also lead the team’s weekly virtual ward round to review
each patient cared for by the team and provide telephone advice as required.
The GP will also receive notification that the team has visited one of their
patients which will detail the nature of the contact and any outcome from it.
Phil Lumbard ECP, EEast Dec2012
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Contact the service on 07714456279
If the contact is via GP direct referral the team would expect telephone
contact with the referring GP to make any final decision regarding the
patient’s care jointly.
3. Quality Care for Older People
The Acute Geriatric Intervention Service has adopted the evidence based, best
practice approached outlined in the publication ‘Quality Care for Older People with
Urgent and Emergency Care Needs’ as well as other nationally recognised guideline.
A summary or full copy of the publication can be found on the British Geriatric
Society website.
4. How to contact the service
You can contact the service by calling:
07714456279
GP direct access criteria
The service is for patients over 75 who are in or at risk of imminent crisis. The
services aim to avert hospital admission, for example;
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Immediate short term management of the acutely ill
Acute delirium or confusional states
Acute decline of function or mobility
An urgent or immediate medical need
A patient requiring a comprehensive multi-disciplinary approach or
assessment urgently ie. Patients with multiple needs.
Inclusion criteria
 Patients over the age of 75
 Patients at their normal place of residence
 Acutely unwell with no red flag symptoms
(eg. Chest pains, severe SoB, head injury with LoC, stroke)
 GP is aware of patient’s premorbid state or has had contact with the patient.
 GP outline of expectations
 A working diagnosis of the problem.
Exclusion criteria
Phil Lumbard ECP, EEast Dec2012
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Contact the service on 07714456279
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Patients under 75 years old
Patients not at usual place of residence
Patients with red flag symptoms
Patients who require 24 hour care
Patients experiencing a social care breakdown (eg. Main carer is unwell and
partner requires respite)
 Single need patients with no urgent requirement (eg. Physio, minor wound
care – DN’s)
 Alcohol abuse/intoxication
 Patients requiring IV treatment
Patient examples for AGIS
Mr Y is 78 and is well known to you. He has had COPD for some years and is on a number of
medications. He lives alone. He has been in hospital 3 times in the past two years. He gets fairly
frequent exacerbations of his COPD and has rescue medication pack in his house. You have spoken
to him and he is able to complete sentences and is not confused but he does sound unwell and you
are concerned that he may have another infection.
AGIS would be very helpful to assess:
Assess patient medically  advise patient to take his rescue medication or initiate treatment
Asses patients functional ability and provide appropriate equipment such as perch stools and frame.
Does he need extra care temporarily?
Do we need to liaise with community respiratory team?
Phil Lumbard ECP, EEast Dec2012
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Contact the service on 07714456279
Miss X is 84 and lives alone. She has a diagnosis of Dementia and is usually able to cope at home
with the support of the Elderly Community Mental Health team. Miss X has daily carers each
morning who assist with washing and dressing and ensure she takes her medication. Miss X’s
relatives do not live nearby.
You have been called as she is feeling unwell with symptoms of a UTI. She has had this before and
subsequently required hospital admission due to increased falls and confusion. She is unwell but it
is not clear whether a hospital admission is required at this time.
AGIS could visit to:
Carry out medical assessment Dip urine and initiate antibiotics for the patient.
Carry out functional and environmental assessment  providing necessary equipment.
Refer to social care team to increase care package  referral to ATT to assist with medication
management.
Patient examples for AGIS
Mrs F lives with her daughter and has ca bladder which she is no longer being treated for and is
now under the palliative care team. Mrs F has had a sudden deterioration in mobility, previously
mobilising with a rollator frame and now requires assistance of two for transfers.
Current pain control is not effective.
Patient wishes to remain at home.
AGIS could visit to:
assess the patients mobility and transfers and provide equipment as appropriate. Liaise with
community team regarding further manual handling.
Review medication to help manage patient’s pain.  Refer back to the palliative care
team/community matrons.
Phil Lumbard ECP, EEast Dec2012
[Type text]
Contact the service on 07714456279
Mr A is 77 years old, he lives in a house alone. He is normally independent with support from his
family who live nearby. He has gradually increasing breathlessness and diet controlled diabetes. He
is a smoker.
His mobility has been gradually deteriorating over the past few months and he has recently
complained of feeling dizzy when he stands. At the moment he is managing to mobilise around the
home but he is furniture walking and seems unsteady. He has fallen today, is unable to get up and
has a skin tear on his arm. He was able to reach the phone to telephone his daughter who has
arrived but she is unable to lift him.
AGIS can visit in order to:
Perform a medical assessment to look for reasons for fall, dizziness and breathlessness.
Provide wound care.
Functional assessment to review what aids/equipment might be needed to minimise risk of further
falls and ascertain if any further support is needed.
Environmental assessment
Liaise with GP and make appropriate referrals such as care line, specialist nursing as appropriate.
Patient examples for AGIS
Mrs Z is an 86 year old female who has become acutely drowsy.
Medication includes paracetamol. amlodipine, digoxin and aspirin.
AGIS can attend to assess with Consultant Geriatrician input;
On examination she is rousable with no focal neurology and no other clinical signs other than an
area of ulceration and cellulitis on her forefoot.
No accurate history is available from the patient.
Antibiotics and blood test will be needed.
Differential diagnosis excluded eg: Dementia, Depression, Hysteria, Dysphasia, Non-convulsive
epilepsy/temporal lobe epilepsy
Need for cognitive assessment/orientation and collateral history gained: Speed of onset and
course of delirium needs to be established. Risk factors for delirium need to be explored - PMH
and Chronic conditions reviewed and Medication review including over the counter/ changes in
medication/adherence.
Phil Lumbard ECP, EEast Dec2012
Risk assessments: safety at home, adequate oral intake and safe mobility. Close liaison with
carer/family member and follow up post-acute event.