Background: An initiative to transform health and social care across the Leeds Healthcare Economy has developed in response to recent demographic, political and economic challenges. Two Interface Geriatricians were appointed to perform various innovative roles across the boundaries of primary and secondary care and to improve patient experience by moving care closer to home.
Innovation: Interface Geriatricians provide early Comprehensive Geriatric Assessment (CGA) by consulting in ED for four sessions per week. We aim to reduce unnecessary admissions from the ED by accessing alternative pathways where appropriate e.g. Intermediate Care or early Geriatric outpatient review. Referral criteria include medically stable frail older people experiencing a change in physical or cognitive function and/or complex co-morbidities. Cases are identified by ED clinicians, the Geriatrician, or the Early Discharge Assessment Team (EDAT) – a team of senior nurses and therapists experienced in arranging complex discharges.
Evaluation: During the first year of the service, 534 patients were assessed during 146 sessions
• 58%of selected patients were discharged from ED – this compares favourably with previous discharge rates from ED for frail older people of 20-33%.
• A further 12% of patients were suitable for discharge but were admitted due to delays accessing community services or investigations.
• Only 27% of selected patients needed admission for medical reasons.
• The readmission rate was similar to the departmental rate of 20%.
• A small reduction in the time waiting to be seen in ED for patients of all ages was demonstrated.
Conclusions: Our innovative, high quality service is avoiding unnecessary admissions with their associated risks and cost. Feedback from ED staff, EDAT and patients regarding our service has been extremely positive. We are developing strong relationships with the ED team and EDAT, extending our influence outside of our allocated sessions and championing the individualised care of frail older people.