Introduction: In August 2012, the Medicine For the Elderly (MFE) department embarked on a 4-week pilot project in Norfolk and Norwich University Hospital, a 950-bedded teaching hospital in Norfolk, England. Approximately 300 of these beds are occupied by patients under MFE teams, who are divided into short stay, orthgeriatrics, stroke, acute and dementia. The pilot involved having a consultant geriatrician in A + E (9 a.m.–5 p.m., Monday to Friday), who would review patients identified by A + E as requiring admission. Suitable patients would then be admitted directly by the MFE team; the patients would be moved to directly to one of five specialist wards (bypassing the MAU).
Methods/results: During the pilot period of 4 weeks, a total of 143 patients (age >75) were reviewed and managed by the consultant geriatrician. Seventy-two percent of patients were seen within 30 min of referral by A + E teams. On average, there were six patients a day and average time to see a consultant geriatrician was 14 min. Average length of stay (LOS) in MAU for patients over the age of 75, dropped from 4.8 to 2.59 days. The percentage of patients in the MFE wards who were discharged within 24 h, increased from 15 to 39%. The LOS during the 4-week pilot period was reduced by 1.22 days, and this led to saving of 30.2 beds per day.
Conclusions: During this pilot, elderly patients were admitted to wards more suited to their needs, with plans made early by a specialist. Patients had less moves within the hospital during their stay, communication and forward planning with the whole team and relatives was much clearer from the outset, which we believe enabled a reduction in the LOS, more same day discharges and improved efficiency.