New service aims to keep frail older people out of hospital

A new service is now in place at the Lister hospital that means frail older people brought in to the hospital’s emergency department, frequently by ambulance, are now referred quickly for assessment by a specialist, consultant-led multidisciplinary team.

In many cases, these individuals may not need to be admitted and with the right care put in place, can return home safely. Where patients do get moved to an inpatient bed, the multi-disciplinary team works with their ward colleagues to ensure that a patient’s stay in hospital is no longer than required. This is because people who are older and frail are at much greater risk of falls when in hospital and their overall mobility can deteriorate more quickly, making their ongoing care even more difficult.

The Trust’s frailty team, with Dr Abdul Malik far right

The Trust’s interface geriatrician, Dr Abdul Malik, explains:

“When an older person who is frail is admitted to hospital, they can be at far greater risk of falls and generally speaking, their overall condition can deteriorate to the point where it becomes harder for them to go on to the next stage of recovery, be it in some form of rehabilitation services or care provided to them in their own home.

“By seeing these patients as soon as they arrive in the Lister’s emergency department, the team can make early interventions that will allow someone to go back home rather than being admitted. Sometimes this means that we will need to work with our community and primary care colleagues to arrange extra services to be provided.”

Dr Rachel Joyce, East and North Hertfordshire CCG’s clinical lead for frailty, said:

“Our overall population is ageing and in ten years’ time, Hertfordshire will have more than 88,000 people aged over 80. Providing these older people with the right care in the right setting is a key priority for all health and social care organisations in this area.

“We know that often the best place for a frail patient to be cared for is at home, rather than in hospital. Even for relatively healthy older people, studies have shown that 10 days in hospital can lead to the equivalent of 10 years muscle ageing.

“People can recover more quickly if they can stay in familiar surroundings, supported by the right care, so it is important to us that people are only admitted to hospital where it is absolutely necessary.

“The specialist frailty team at the Lister is there to help make sure older, vulnerable patients receive the help they need quickly. The specialist carries out a thorough assessment when a patient arrives in A&E to make sure they are comfortable, arrange for any tests that are needed and – where it is clinically appropriate, and arrange for the right support to be provided at home.”

The triage nurses in the Lister’s emergency department now follow a protocol to help them identify those patients who need to be assessed by the frailty assessment team. Currently the service operates between 9.00am and 4.00pm daily, Monday to Friday; outside of these times, patients continue to be cared for by the emergency department team, supported by speciality colleagues as required.