524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

scholarly journals 17 Improving Frailty Identification and Comprehensive Geriatric Assessment (CGA) Completion on the Wards

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
D Verma ◽  
F Bonora ◽  
R Walker ◽  
M Kaneshamoorthy ◽  
L Bafadhel
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Elderly Care ◽  
Frail Older People ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Qualitative Feedback ◽  
Complicated Course ◽  
User Friendly

Abstract Introduction The Comprehensive Geriatric Assessment (CGA) is known to deliver substantial and measurable health improvements to frail older people, including increased independence and a reduction in mortality.1 The Clinical Frailty Scale (CFS) can detect older adults at higher risk of complicated course and longer hospital stay.2 Despite the known benefits, previous audits has shown poor documentation on geriatric wards at Southend Hospital. Therefore, we devised a Quality Improvement Project to improve the uptake of both these. Methods A total of two Plan Do Study Act (PDSA) cycles were completed where CGA completion and CFS documentation was audited. Each cycle lasted two weeks (25 patients). Qualitative feedback was obtained from the members of multidisciplinary team to aid improvements. The baseline audit was based on the introduction of a 2-page ward proforma for all new patients. The first intervention was an improved 2-page ward-proforma. The second intervention was a single page ward-proforma. Results Originally, 40% of new patients admitted onto the ward had a CGA assessment and CFS score. After the first intervention, 79% (19) patients had a CFS score and a CGA assessment. 21% had a full CGA completed and 58% had partial CGA. Feedback included wanting a single page proforma to increase uptake. Questions needed to be more unambiguous and more tick boxes. After the second intervention 100% (25) patients had a CFS score and a CGA assessment. 40% (10) had a full CGA completed and 60% (15) had a partial CGA. Feedback include incorporating the ward round documentation to avoid repetition. Conclusions The results show that by using a focused, concise and user-friendly proforma, uptake of the Comprehensive Geriatric Assessment and Clinical Frailty Scale can be significantly increased, bringing substantial and measurable health improvements to frail older people admitted to elderly care wards. References 1. Welsh TJ, Gordon AL, Gladman JR. Int J Clin Pract. 2014;68(3):290–293. 2. Juma S, Taabazuing MM, Montero-Odasso M. Can Geriatr J. 2016;19(2):34–39.

scholarly journals Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

2020 ◽  
Author(s):  
Andrew C. Nixon ◽  
Julie Brown ◽  
Ailsa Brotherton ◽  
Mark Harrison ◽  
Judith Todd ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Screening Programme ◽  
Management Plan ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Quality Improvement Project ◽  
Clinical Frailty Scale ◽  
Improvement Project ◽  
Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

10 Improving Communication About Death Between Primary and Secondary Care: A Quality Improvement Project

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Arumugam ◽  
R Laud ◽  
P Naydenova
Keyword(s):  
Quality Improvement ◽  
Discharge Summary ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Improvement Project ◽  
Lack Of Information ◽  
Discharge Letter ◽  
Death Notification ◽  
Electronic Discharge Summary ◽  
Hospital Teams

Abstract Introduction Communication between the hospital and primary care regarding the death of a patient is incredibly important. Previous literature surrounding this area has shown that it is often done poorly, resulting in substandard documentation. Furthermore, lack of information for General Practitioners (GPs) means it is difficult for them to enter discussions with families, which can negatively impact on the bereavement process. The previous expectation was that an electronic discharge summary was completed, but that this was not optimally designed to inform GPs about the circumstances surrounding the death. Reasons given that summaries were not completed included: the busy workload of junior doctors and the lack of awareness of their importance. Methods The aim of our quality improvement project was to ensure 80% of GPs received notification and information about a patient’s death by August 2018. Following an initial cycle to assess the baseline notification rates, we developed a standardized death notification letter following feedback from local GPs. This included information such as date of death, if the coroner had been informed and a brief summary of events. Following introduction of the letter, we recorded the uptake and then gained further feedback regarding the ways in which it could be improved. A final cycle was then implemented. Results Baseline data showed an electronic discharge letter was only being completed in 13.3% of cases (n=3/21). Following introduction of the new letter, 83.6% were completed (n=56/67). Conclusions In conclusion, the introduction of a simple and standardized letter template has vastly increased the notification of GPs about a patient’s death from our hospital. Limitations of our project included the varying numbers of deaths in audited periods and some hospital teams having a separate process in place.

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