Innovative ED older persons’ care: A report on an initiative developed in Southampton Hospital ED
Introduction
The delivery of older persons’ health care is never far from the media gaze, with the publication of the Care Quality Commission (CQC in UK) Report (2011) finding alarming deficits in the care of older people (BBC, 2012). This is reflected worldwide with older persons care reported as being fragmented in countries as diverse as Israel, Canada and the USA (Clarfield et al., 2001). With the predicted growth in the global older population and increased economic constraints, there is a need for cost effective, innovative ways to develop older persons’ care. Facilitating quality care for older people within the emergency department (ED) can pose a significant challenge when quality indicators are measured more on speed rather than patient experience. A specialist multidisciplinary team has been in place in the ED of University Hospital Southampton Foundation Trust for the last 8 years, to ensure quality care for older people. This team includes specialist nurses, therapists and social workers and works alongside the regular acute care doctors and nurses. This paper will describe the service offered, by benchmarking against a quality framework. In the UK this is billed as the QIPP agenda, which is a specific service initiative focussing on quality healthcare provision (Irani, 2011).
Section snippets
Demography
With an evolving health service, it is important to understand that population ageing and an increase in the total number of older people (defined globally as those over 60 years of age), is an international phenomenon and not simply experienced by economically developed countries. Indeed, the global figures suggest that the total number of older people is set to double within the next 50 years – from 606 million in 2000 to over 1.2 billion in 2050 (UN Population Division, 2003).
The world
History of OPOST
Initially, the team began with funding from The Modernisation Agency in 2003, to improve the management of older person care within hospital settings. Standards were set out in the National Services Framework for Older People (2001) and focussed on Standard 4 (General Hospital Care). The team worked across three care areas (Medicine, Surgery and ED), within the Acute Hospital (Chambers, 2004). Key functions included:
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Improving the discharge planning process.
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Improving the clinical management of
Service provision
One of the best ways of assessing the team’s success is by measuring activity with the current QIPP Agenda. The Agenda is divided into a number of specific workstreams, two of which are concerned with long term conditions and urgent care. Interfacing with community and social care teams is essential in order to facilitate ongoing support for patients with long term conditions. The team’s role is to ensure that patients feel empowered to make informed decisions about ongoing healthcare and
Conclusion
Demographic trends and patterns in life expectancy suggest that the increasing population of older people worldwide will continue. The ED will face increasingly high numbers of older people in the future with complex co-morbidities and social care needs. In order to achieve high quality care for older people and meet quality care indicators, the intervention of a highly skilled, multi-professional team is essential. This will maximise the quality of care provided, whilst making the most
Acknowledgements
Prof. Avan Ahie Sayer has offered invaluable support in putting this paper together, as well as the rest of the OPOST Clinicians, Alex Sims, Gary Cleeve, Sarah Stephens, Terrie Smith, Helen Crowe, Jo Oakes and Rosey Holland, Liz Onslow and our Care Managers David Bradley, and Jo Buckle and administrator Balvinder Mandair.
Dr Nadia Chambers was the inspiration for the inception of the team, and her drive and determination to ensure excellent quality of care for older people has continued to
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