Background: An initiative to transform health and social care across the Leeds Healthcare Economy has developed in response to recent patient 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: In Leeds, community staff including General Practitioners (GPs) access admission to hospital via the Primary Care Access Line (PCAL) – a team of senior nurses trained to triage and signpost appropriate patient pathways. One Interface Geriatrician role is working with PCAL to provide rapid access to specialist advice. Alternative pathways such as Intermediate Care, early Geriatric outpatient review or prompting advance care planning, are suggested and arranged.
Evaluation: During the first year of the service, 174 patient discussions took place
• In 19% of patients, an admission was avoided altogether.
• A further 7% of patients were admitted within 30 days, usually for unrelated reasons. This is substantially less than the current departmental readmission rate of 18%.
12%: of patients were redirected to Intermediate Care, attended hospital for an assessment only or had urgent Geriatric outpatient appointments arranged.
• GP feedback indicates they value the ease of access to a Geriatrician for clinical advice.
Conclusions: Our innovative service is avoiding unnecessary admissions with their associated risks and cost. Patients in whom an admission is avoided are less likely to be admitted later than patients recently discharged from hospital. One limitation is the availability of the Interface Geriatrician to participate in a discussion during other clinical sessions. We believe that ring-fencing Geriatrician time to provide and extend this service may confer larger benefits. We are developing strong relationships with local GPs and the senior PCAL nurses, thereby extending our influence beyond these patients.