CGA

Introduction

The Same Day Emergency Care Older Person’s Unit (SDEC OPU) provides urgent holistic care, complementing acute and community services to deliver comprehensive geriatric assessment. In October 2022, we introduced a new clinical coordinator role with the aim of improving patient flow. Prior to this role existing, one clinician per day was assigned to take referrals alongside reviewing their own patients, without having an overview of the processes and outcomes of the day. The new clinical coordinator role included taking referrals, vetting patients in A&E, assigning tasks to clinicians, leading regular ‘huddles’, reviewing results, preparing notes and discharge letters, and requesting specialty referrals. The role was introduced to reduce the waiting time of patients within the unit and to reduce waste through the Leeds Improvement Method.

Method

Data was analysed from a 13 week period both before and after the role was implemented, with the main focus being patient length of stay. 454 patients from before the clinical coordinator role was introduced, and 360 patients following its introduction were included.

Results

Mean length of stay was calculated at 5hr 11minutes before the role introduction and 4hr 45minutes afterwards. This reduction in length of stay was statistically significant (p=0.015), with a 95% confidence interval where length of stay was reduced between 8 and 43 minutes (p=0.0029). The percentage of patients discharged within 4 hours of arrival was 30.4% before the implementation and 36.7% after it. This was not statistically significant (p=0.0593). The percentage of patients discharged over 7 hours after arrival was 19.8% before the implementation and 13.3% after it. This was statistically significant (p=0.0143).

Conclusion

The introduction of a bespoke clinical coordinator role within SDEC OPU significantly reduced patients’ length of stay. It has also provided leadership to the team, increased efficiency, and improved patient experience.

Introduction

People with frailty (Rockwood Frailty Score of 4 or more) represents 43% of the medical take at Withybush Hospital. There was a lack of front door frailty and comprehensive geriatric assessments (CGA). It was postulated that this was leading to delays in discharge and limiting the number of patients receiving a CGA by teams led by a geriatrician

Methods

In mid-November 2022, the acute medical take was adapted to stream stable patients with frailty through a frailty assessment unit. Prior to this, the area was being used as a surge ward for short stay acute medical patients. On the frailty unit, patients receive a CGA creating a problem list and plan. The patients are then streamed into either short stay and discharged from the unit itself or to an appropriate ward area. Number of discharges was the main outcome measure.

Results

In the 2 months preceding the intervention the number of discharges from the short stay assessment unit was 16% of total medical discharges. The percentage of patient’s discharged from frailty wards was also 16% of medical discharges. In the 2 months after the intervention, discharges from the frailty unit accounted for 21% of medical discharges. Discharges from the frailty wards accounted for 16% of medical discharges. In the post intervention months, the frailty team discharges accounted for 37% of total medical discharges. 

Conclusions

Adoption of frailty unit model improved rates of short stay discharges and allowed frailty team to assess a greater proportion of the hospital patients. Using assessment by the frailty teams as a surrogate for a CGA this has significantly improved the proportion of patients receiving CGA to more fit our patient demographics.