Project Description

Transformation of frail and elderly care

Large Midlands Acute NHS Trust


The aim of the project was to improve quality and performance across frail elderly services and the frail elderly pathway, whilst shifting care from an acute to a community environment.

This involved;

  • Working across both commissioner and provider organisations, an increasing need was recognised to innovate and improve frail elderly care locally.
  • A service strategy for frail elderly care was produced in conjunction with key stakeholders, communicated simply through a “strategy on a page”, highlighting key aims of shifting care to the community whilst improving acute care quality.

What we did

Our support included;

  • Implementation of a front-door A&E geriatrician with a rapid assessment and treatment therapy team
  • Rapid access elderly care clinics, through consultant job review, supporting admission avoidance

  • Nurse-led falls clinics and community IV therapy provision

  • Launch of a dementia steering group and specialist dementia nurses

  • Implementation of an early supportive discharge service and discharge “clearing house”

  • Joint geriatric/ psychiatry clinics for holistic cognitive assessment and treatment of elderly patients

  • The strategy and implementation were supported through reviewed governance, workforce and performance structures

Our impact

Our results included;

  • A sustained improvement of nursing quality metrics above 90%, including indicators relating to pressure ulcer incidence, nutrition scores and patient observation
  • Improved patient experience sustained at over 91% for all elderly care wards

  • Rapid access to specialist elderly assessment and treatment, reducing falls and adverse incidents

  • Reduction in average length of stay by around 7 day

  • Reduction in unnecessary A&E attendances and admissions

  • 10% reduction in occupied bed days

  • 5% increase in monthly discharges

  • 30% reduction in nursing spend due to reduced sickness and cover required

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