20INTEGRATED CARE OF OLDER PEOPLE (ICOP): A NEW SERVICE DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) ON THE ACUTE ASSESSMENT UNIT AT SINGLETON HOSPITAL: RESULTS OF 2 PDSA CYCLES

Abstract

Topic: New models of holistic integrated care are required to meet the complex needs of older people presenting at point of crisis to acute medical units. Significant advances in community services including acute clinical teams have allowed medical care and reablement to be provided closer to patient's homes. Prior to 2017 there was no dedicated therapy input in the assessment unit and only a minority of patients ever received comprehensive geriatric assessment (CGA). Intervention: During the first PDSA cycle in 2017 a dedicated multidisciplinary team undertook CGA for 118 patients aged over 75 presenting with a frailty syndrome. Discharges directly from the assessment unit increased with improved access to community services. A successful business case permanently embedded the service and a second PDSA cycle commenced. Improvement: Between September-November 2017 the iCOP team undertook CGA on 152 patients (23% of total number of acute patients aged >75). Average age 85 years and 75% had a Rockwood clinical frailty scale of >6. 55.1% were discharged directly home (48% in the pilot) and 62.9% of patients were referred to community teams on discharge. Of the 44.9% that were transferred within the hospital, 61.4% were placed on an older persons ward where CGA and frailty specific care could continue. 80.8% were admitted on 6 or more medications and average medication was reduced from 7.6 to 7.1. 70% received a cognitive assessment and 60% had a do not resuscitate decision documented. Discussion: iCOP established an integrated approach to acute care overcoming traditional health and social care boundaries. Excellent links with community teams have allowed medical treatment and rehabilitation to be delivered in community settings. Patients requiring inpatient CGA have been fast tracked to a care of older persons ward delivering the right care in the right place at the right time.