accident emergency, front door and discharge planning Flashcards
(42 cards)
1
Q
what was increased in frail individuals compared to non- frail individuals?
A
- mortality after 2 years was increased
2
Q
what do patients in the ambulatory cohort classified as frail have an increase in? (2)
A
- increased mortality and hopsital use
3
Q
what are the 4 processes of acute hospital front door admission?
A
- preadmission
- hospital attendance
- admission
- community
4
Q
what are the three methods of preadmission?
A
- GP
- 111
- 999
5
Q
what are the 2 types of hospital attendances?
A
- emergency department
- alternative admission area
6
Q
what are the two types of admission?
A
- medical admission unit
- other subspeciality admission
7
Q
how do you facilitate an expert assessment of the patient’s needs?
A
- connecting community services with specialist frailty secondary care advice facilitates an expert assessment
8
Q
what is SDEC?
A
- same day emergency care services
9
Q
what are the 2 ways that care is optimised pre- admission?
A
- community based interventions
- scheduled secondary care reviews
10
Q
when is a sensible point of intervention for frail individuals and why?
A
- often conveyed to hospital by ambulance so it is a sensible point of intervention
- aims to avoid hospital attendances where possible
11
Q
who is the pre-admission system run by?
A
- ran by a frailty team
12
Q
who runs a frailty team?
A
- run by a geriatrician working on a frailty of SDEC unit or as part of a service providing frailty expertise to EDs
13
Q
what do frailty services within the ED facilitate? what is this rather than?
A
- facilitate proactive rather than reactive patient reviews
14
Q
what do frailty services within the ED prioritise?
A
- prioritise getting the right patient to the right team as quickly as possible
15
Q
what do frailty services identify?
A
- identify those with complex needs that the ED cannot address
16
Q
what do unwell patients with frailty often require?
A
- require more comprehensive and joined- up management
17
Q
what is effective in terms of prioritising patients?
A
- prioritising patients who have recently been discharged from geriatric medicine wards or patients attending care homes can be effective
18
Q
how are geriatric medicine ward patients or care home patients managed? what does this make more likely?
A
- managed by the FDF service
- more likely that admission can be avoided and prearranged social care can be maintained
19
Q
what method is most used for initial scoping work of front door frailty services?
A
- in reach or liaison work
20
Q
what do rapid reviews at ambulance arrival enable? what does it limit?
A
- 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
21
Q
what have many sites promoted?
A
- ACP
- advanced clinical practitioner
22
Q
what is ACP alongside?
A
- alongside therapy teams to support the ED with the identification of patients can be managed in the community with simple interventions
23
Q
what can ACP initiate?
A
- can initiate a CGA independently with close support from a geriatrician and enact a referral to community services
24
Q
what have ACP teams developed?
A
- developed specific pathways for common conditions affecting older people with frailty
25
what are the three common conditions affecting older people with frailty?
- fracture
- loss of independent mobility
- falls with head injury
26
what do the pathways for common conditions of frail individuals enable?
- enables rapid structured assessment for potential community management
27
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
28
how do in- reach teams complement the work in the frailty unit?
- work as mobility assessment teams for more straightforward reviews
29
what was created for frail individuals within the ED?
- creation of a dedicated space within the ED to review patients with frailty can enable the MDT to work more effectively
30
what does the frailty ED space provide?
- provides two- way learning opportunities
31
what does the frailty ED space upskill the team to understand?
- understand subtle presentation through repeated direct collaborative working
32
what is patient selection through for frailty ED spaces?
-patient selection through ED admission screening for case identification
33
what healthcare professionals are specialised for frailty care? what should they be included in?
- geriatricians
- should be included in a frailty ED space
34
what areas allow rapid MDT working?
- SDEC
- frailty unit
35
what does frailty unit decide?
- decides on hospital admission or discharge in a short stay
36
what is the dual focus of frailty units?
- to provide an assessment SDEC area as well as a bedded facilty for those who are likely to require admission and need a proactive approach
37
what does co- location of SDEC and frailty unit enable?
- enables the sharing of the MDT resource and the ability to take a more extensive spectrum of patients with frailty
38
what are more suitable locations for frail individual assessment? why?
- frailty units are more suitable as they provide space to wander and a calmer environment compared to ED
- staff have skill set to manage patients who may have cognitive impairments
39
what is the SDEC space also used for?
- hot- clinic
- for scheduled reviews through an admission avoidance pathway
- although ensuring this maintains rapid access is priority
40
how can early supported discharge be assisted?
- virtual ward or hospital at home teams
- discharge to assess pathways
- general practitioners with specialist interest who can support the proactive workstreams of community frailty interventions alongside care home reviews and proactive patient discussions
- local age UK branches and other voluntary services providers
- community specialist nurses
- British red cross
- hospice at home provision
- community geriatricians
- silver phone/ consultant connect services
- rapid access CGA clinic
- community hospitals
41
what does the statutory guidance of hospital discharge and community support set out?
- sets out how health and care systems can ensure that people:
1. are discharged safely from the hospital to the most appropriate place
2. can continue to receive the care and support they need after they leave hospital : documented discharge plan
42
when does discharge planning start?
- starts on admission or before elective procedures
