Lightbulb innovation: the care and dignity of older people in hospital

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"Preventing frail elderly patients from being treated in the Accident & Emergency (A&E) department, and maintaining the dignity of these vulnerable people, lies at the heart of this fundamental service redesign", says Amanda Futers, manager of the Frail Elderly Assessment Unit, which opened in 2010 at the University Hospital of North Staffordshire.

An evaluation in 2010 of how frail elderly care was delivered in an acute trust to the older population in Stoke-on-Trent identified multiple patient transfers, extensive lengths of stay and delays in geriatrician review and specialist care delivery. Since then, the Elderly Care team have undergone a radical transformation through the development of the Frail Elderly Assessment Unit, the main purpose of which is the rapid holistic assessment of older people.

In the past, all hospital admissions were assessed via A&E, and older people often ended up in environments that could not fully meet their complex care needs. Not only was this detrimental to patient health outcomes, it was also difficult for the healthcare professionals, who often found themselves caring for patients with very different levels of acuity in the same ward.   Now, decisions are made by a multidisciplinary team of medics, nurses and therapists, who are specialists in the complex care of older people, to ensure that patients are assessed and treated in the most appropriate place for their needs. This may be at home with support from community teams, a "step-down" facility in a community setting, or an acute bed in the hospital. The integrated multidisciplinary team also includes community assessment teams (social workers, complex health nurse assessors and psychiatric nurses).

Fiona Howell, matron for elderly care, said: "Frail, older people need to be looked after in a specific way. They tend to be the patients that stay longest in hospital and need a lot of input from other teams such as social services and physiotherapists. On this unit we can give them the specialist approach to their care that they wouldn't get in A&E." Most initial assessments are made within 15 minutes of admission, with a decision to admit or discharge in under 24 hours.

During its development, it became evident that the concept of the Frail Elderly Assessment Unit was unique to the University Hospital of North Staffordshire and to date no comparable examples across the UK have been identified. Despite the infancy of this initiative, multiple benefits for patients and staff have already been identified and these include:

In October 2012 the FEAU moved into a purpose built unit cohorted with the acute elderly admission wards.  This provides a seemless journey for the patient.  The unit consists of 20 beds (10 female and 10 male) and complies to the single sex agenda.  

There has been national interest in this project with visits from various trusts to replicate this work and the Unit and the Elderly Care wards have recently been assessed for an Excellence in Practice Accreditation award.

Not only has the Frail Elderly Assessment Unit been featured in the hospital's internal newsletter, but it has also been presented at the RCN 2012 Older People forum conference in March this year.

Further information

If you'd like to know more about this innovation, please contact Amanda Futers, email: Amanda.futers@uhns.nhs.uk.

 

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