25IMPLEMENTATION OF THE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) PROCESS IN AN ACUTE HOSPITAL IMPROVES THE QUALITY OF DISCHARGE

Abstract

Topic: Older people frequently move between services and organisations and are therefore susceptible to the effects of multiple assessments and delays typical of poorly integrated services. CGA has been shown to reduce morbidity. However, mechanisms to ensure personalised care plans remain responsive to the patient's needs after discharge are not always robust with lack of clarity of MDT roles and responsibilities. Intervention: To start the CGA process during admission and to follow patients home post discharge to identify opportunities for targeted service improvement. Older patients admitted to the Acute Medical Unit were assessed using an Older Person's Proforma. Two Advanced Clinical Practitioners (ACP) identified patients with frailty using the Clinical Frailty Scale (CFS) and discussions with the multidisciplinary team. 53 patients were followed through hospital and home. Improvement: The proforma encouraged multi-disciplinary assessment of patient's needs and identified patients with high levels of complexity. 50/53 older patients with frailty (CFS > 6) experienced a problem within 48 hours after return home even though discharge had been planned. These were: Medication problems: lack of clarity on medication use; complex discharge summary; drugs rationalised in hospital but restarted from existing tablets at home; nonconcordance. Functional problems: significant unexpected decrease in mobility and cognition on discharge "the post discharge dip". Anxiety: distress experienced by patient and family. Verbal information given whilst an inpatient not remembered, written information not read. Unresolved medical issues: i.e. unsure if breathing will improve Exhaustion: lack of sleep whilst inpatient; trauma of transfer home. Care issues: lack of clarity as to what care to expect Discussion: Complex patients with frailty are at high risk of functional decline after discharge that is grossly under recognised. When implemented, CGA can help to predict which patients may experience problems which can then be addressed by integrated case management that ensures the needs of the patient are met over time.