2A PROACTIVE GERIATRIC LIAISON SERVICE TO ASSESS AND MANAGE MEDICAL PROBLEMS ON OLD AGE PSYCHIATRY WARDS

Abstract

Topic: Older people with mental health problems are more likely to receive lower quality health care, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality [1, 2, 3]. The NHS mandate 2015 to 2016 emphasises the need to deliver care which is joined up and seamless for users of services [4]. Many patients with mental ill health have coexistent medical problems, yet they are often managed in 'stand-alone' psychiatric facilities with little input from medical specialties. We audited the impact of a 'geriatric liaison service' to an old age psychiatry unit in Leeds. Intervention: We audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds which consists of 4 Old Age Psychiatry wards. Data was collected in October 2015 and included referral date, patients' age and sex, number of referrals, reason for referral and the outcome. Improvement: 339 (142F, 197M) with a mean age 77 years (range 56-94) were referred, some more than once (range 1 - 8) making 440 referrals in total. Cardiovascular problems were the biggest group of referrals (in particular oedema, hypotension and rhythm disturbances) (34%) followed central nervous system problems (11%), respiratory (8%), gastrointestinal (8%) and infection (8%). The most common intervention was advice on treatment or investigation, very few patients needed acute admission and some unnecessary admissions were aborted by physician's intervention. Some unusual problems were diagnosed, a spontaneous pneumothorax and primary biliary cirrhosis. Discussion: This audit emphasises the need for a joint coordinated approach on psychiatric wards and a dedicated Geriatric Liaison service can improve care, avoid unnecessary acute admissions and repeated outpatient appointments. There are also excellent opportunities for junior staff training particularly at Foundation level. As a result of the service model, a simulation-training course is being developed for staff working on the Old Age psychiatry wards from the commonest scenarios identified by the audit. This will help to facilitate training by teaching to recognise, assess and manage common medical problems in psychiatric settings.