scholarly journals 99THE BROMHEAD SERVICE: PHASE 2. SERVICE IMPLEMENTATION OF COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) AND ADVANCE CARE PLANS (ACPS) FOR CARE HOME RESIDENTS IN LINCOLN

2018 ◽  
Vol 47 (suppl_2) ◽  
pp. ii25-ii39
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Care Home ◽  
Phase 2 ◽  
Care Plans ◽  
Advance Care

scholarly journals Measuring Quality of Service in a Robotized Comprehensive Geriatric Assessment Scenario

2020 ◽  
Vol 10 (18) ◽  
pp. 6618
Author(s):  
Adrián Romero-Garcés ◽  
Jesús Martínez-Cruz ◽  
Juan F. Inglés-Romero ◽  
Cristina Vicente-Chicote ◽  
Rebeca Marfil ◽  
...  
Keyword(s):  
Quality Of Service ◽  
Functional Properties ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
User Preferences ◽  
Care Plans ◽  
Whole Process ◽  
Frail Elderly People ◽  
Individualised Care

Comprehensive Geriatric Assessment (CGA) is an integrated clinical process to evaluate frail elderly people in order to create therapy plans that improve their quality and quantity of life. The whole process includes the completion of standardized questionnaires or specific movements, which are performed by the patient and do not necessarily require the presence of a medical expert. With the aim of automatizing these parts of the CGA, we have designed and developed CLARC (smart CLinic Assistant Robot for CGA), a mobile robot able to help the physician to capture and manage data during the CGA procedures, mainly by autonomously conducting a set of predefined evaluation tests. Using CLARC to conduct geriatric tests will reduce the time medical professionals have to spend on purely mechanical tasks, giving them more time to develop individualised care plans for their patients. In fact, ideally, CLARC will perform these tests on its own. In parallel with the effort to correctly address the functional aspects, i.e., the development of the robot tasks, the design of CLARC must also deal with non-functional properties such as the degree of interaction or the performance. We argue that satisfying user preferences can be a good way to improve the acceptance of the robot by the patients. This paper describes the integration into the software architecture of the CLARC robot of the modules that allow these properties to be monitored at run-time, providing information on the quality of its service. Experimental evaluation illustrates that the defined quality of service metrics correctly capture the evolution of the aspects of the robot’s activity and its interaction with the patient covered by the non-functional properties that have been considered.

Acute medicine and the older patient

2019 ◽  
pp. 891-906
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Palliative Care ◽  
Geriatric Assessment ◽  
Advance Care Planning ◽  
Comprehensive Geriatric Assessment ◽  
Fragility Fractures ◽  
Care Planning ◽  
Older Patient ◽  
Acute Medicine ◽  
Advance Care ◽  
Acute Confusion

This chapter discusses the older patient on the acute unit, including how to assess the older patient, assessing frailty, the comprehensive geriatric assessment (CGA), falls and collapse, fragility fractures, acute confusion syndrome (ACS), and palliative care and advance care planning.

scholarly journals 28 Can Comprehensive Geriatric Assessment be Achieved in the Emergency Department?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
J Cheng ◽  
C Ho ◽  
K Honney ◽  
M Wells ◽  
W Wise ◽  
...  
Keyword(s):  
Emergency Department ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Average Length ◽  
University Hospital ◽  
Emergency Setting ◽  
Care Plans ◽  
Average Length Of Stay ◽  
Standard Tool ◽  
The Uk

Abstract Background Our National Health Service is facing unprecedented challenges to accommodate our frailer healthcare users. The gold standard tool for the identification and management of frailty is the Comprehensive Geriatric Assessment (CGA) and has been shown to lead to better outcomes in terms of morbidity and mortality. Introduction With a largely elderly demographic profile in the East of England, the Norfolk and Norwich University Hospital opened the first Older People’s Emergency Department (OPED) in the UK in 2017. This work reviews the effectiveness of a geriatrician-led CGA in a dedicated OPED, which operates during daylight hours, compared to usual care in Accident & Emergency (A&E). Methods 99 patients assessed in OPED and 99 patients assessed overnight in A&E during February 2019 were included in this retrospective study. Electronic case notes for each patient were reviewed by the authors and results were expressed as percentages. Results OPED outperformed A&E in all components of the CGA; strongest areas included assessing for pain, falls risk and activities of daily living. Both departments performed well in reviewing medications and assessing for safeguarding concerns. Areas for improvement include assessing for mood disorders, sensory impairment, discussing Do Not Attempt Cardiopulmonary Resuscitation status, and end of life care plans. The average length of stay of OPED patients was only 7.3 days compared to 8.7 days in A&E, and 89% of OPED patients were discharged back to their usual residences compared to 87% in A&E. Conclusions The improved CGA process in OPED has led to better outcomes, notably through a reduction in the average length of inpatient stay. Nevertheless, certain components of the CGA still require improvement. Further examination is needed to assess long-term mortality to support the use of CGA in the emergency setting.

scholarly journals 41 A New Ambulatory Frailty Pathway at Barnsley Hospital

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
W Rycroft ◽  
B Madi
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Discharge Rate ◽  
Patient Journey ◽  
Acute Medical Unit ◽  
Frail Patients ◽  
Standard Management ◽  
Same Day Discharge ◽  
Ambulatory Patients ◽  
Advance Care

Abstract Topic At Barnsley Hospital we targeted an improvement in the care of frail patients. The first objective was to improve the patient journey by reducing the amount of time that frail patients spend in busy acute environments. The second objective was to deliver more effective Comprehensive Geriatric Assessment which is recognised as gold standard management (Ellis, G. BMJ 2011;343:d6553). Intervention A new frailty chaired area was opened in July 2018 with capacity to receive up to 6 patients per day from acute admission areas and aim for same day discharge. We developed our own bespoke criteria to ensure that suitable ambulatory patients were identified to access this new pathway. This was called “FACT” Criteria- Frail, Ambulatory, Clinically stable, Time to call. Patients received an MDT model of care which was documented using a newly developed electronic tool called electronic Comprehensive Geriatric Assessment (eCGA). Improvement To evaluate the patient journey we measured the average time between the Acute Medical Unit (AMU) Post Take Ward Round (PTWR) and onward move. Comparison was made between the 2 month periods July—August and November—December 2018. This demonstrated that the average time reduced from 10.3 to 5.1 hours. Between July 2018 and April 2019 a total of 689 patients were assessed in the frailty chaired area of which 60.8% were discharged from the hospital the same day. Discussion The patient journey for frail ambulatory patients now involves significantly less time on AMU awaiting onward move. Comprehensive Geriatric Assessment is delivered more effectively and documented electronically using eCGA. This tool promotes better information sharing and has a specific section for advance care planning. This new pathway has a high same day discharge rate of 60.8% which reduces length of stay for our frail patients.

scholarly journals Using comprehensive geriatric assessment for quality improvements in healthcare of older people in UK care homes: protocol for realist review within Proactive Healthcare of Older People in Care Homes (PEACH) study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017270 ◽  
Author(s):  
Maria Zubair ◽  
Neil H Chadborn ◽  
John R F Gladman ◽  
Tom Dening ◽  
Adam L Gordon ◽  
...  
Keyword(s):  
Older People ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Care Home ◽  
Realist Review ◽  
Community Dwelling ◽  
Systematic Search ◽  
Care Homes ◽  
British Society ◽  
Home Setting

IntroductionCare home residents are relatively high users of healthcare resources and may have complex needs. Comprehensive geriatric assessment (CGA) may benefit care home residents and improve efficiency of care delivery. This is an approach to care in which there is a thorough multidisciplinary assessment (physical and mental health, functioning and physical and social environments) and a care plan based on this assessment, usually delivered by a multidisciplinary team. The CGA process is known to improve outcomes for community-dwelling older people and those in receipt of hospital care, but less is known about its efficacy in care home residents.Methods and analysisRealist review was selected as the most appropriate method to explore the complex nature of the care home setting and multidisciplinary delivery of care. The aim of the realist review is to identify and characterise a programme theory that underpins the CGA intervention. The realist review will extract data from research articles which describe the causal mechanisms through which the practice of CGA generates outcomes. The focus of the intervention is care homes, and the outcomes of interest are health-related quality of life and satisfaction with services; for both residents and staff. Further outcomes may include appropriate use of National Health Service services and resources of older care home residents. The review will proceed through three stages: (1) identifying the candidate programme theories that underpin CGA through interviews with key stakeholders, systematic search of the peer-reviewed and non-peer-reviewed evidence, (2) identifying the evidence relevant to CGA in UK care homes and refining the programme theories through refining and iterating the systematic search, lateral searches and seeking further information from study authors and (3) analysis and synthesis of evidence, involving the testing of the programme theories.Ethics and disseminationThe PEACH project was identified as service development following submission to the UK Health Research Authority and subsequent review by the University of Nottingham Research Ethics Committee. The study protocols have been reviewed as part of good governance by the Nottinghamshire Healthcare Foundation Trust. We aim to publish this realist review in a peer-reviewed journal with international readership. We will disseminate findings to public and stakeholders using knowledge mobilisation techniques. Stakeholders will include the Quality Improvement Collaboratives within PEACH study. National networks, such as British Society of Gerontology and National Care Association will be approached for wider dissemination.Trial registration numberThe realist review has been registered on International Prospective Register of Systematic Reviews (PROSPERO 2017: CRD42017062601).

scholarly journals Using advance and emergency care plans during transfer decisions: A grounded theory interview study with care home staff

2021 ◽  
pp. 026921632110593
Author(s):  
Fawn Harrad-Hyde ◽  
Natalie Armstrong ◽  
Chris Williams
Keyword(s):  
Grounded Theory ◽  
Care Home ◽  
Care Homes ◽  
Structured Interviews ◽  
Care Home Staff ◽  
Care Plans ◽  
Modifiable Factors ◽  
Advance Care ◽  
The Moment ◽  
Staff Experiences

Background: Advance care planning has been identified as one of few modifiable factors that could reduce hospital transfers from care homes. Several types of documents may be used by patients and clinicians to record these plans. However, little is known about how plans are perceived and used by care home staff at the time of deterioration. Aim: To describe care home staff experiences and perceptions of using written plans during in-the-moment decision-making about potential resident hospital transfers. Design: Qualitative semi-structured interviews analysed using the Straussian approach to grounded theory. Setting/participants: Thirty staff across six care homes (with and without nursing) in the East and West Midlands of England. Results: Staff preferred (in principle) to keep deteriorating residents in the care home but feared that doing so could lead to negative repercussions for them as individuals, especially when there was perceived discordance with family carers’ wishes. They felt that clinicians should be responsible for these plans but were happy to take a supporting role. At the time of deterioration, written plans legitimised the decision to care for the resident within the home; however, staff were wary of interpreting broad statements and wanted plans to be detailed, specific, unambiguous, technically ‘correct’, understood by families and regularly updated. Conclusions: Written plans provide reassurance for care home staff, reducing concerns about personal and professional risk. However, care home staff have limited discretion to interpret plans and transfers may occur if plans are not specific enough for care home staff to use confidently.

scholarly journals ASSESSING AT-RISK OLDER ADULTS THROUGH THE RAPID GERIATRIC ASSESSMENT

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S186-S186
Author(s):  
Marla Berg-Weger ◽  
John Morley
Keyword(s):  
Geriatric Assessment ◽  
Total Sample ◽  
Population Based ◽  
Health Condition ◽  
Rapid Screening ◽  
Care Plans ◽  
Healthcare Settings ◽  
Advance Care ◽  
Race Ethnicity ◽  
National Prevalence

Abstract With the need to increase gerontological competency among all health/social service professions, the Rapid Geriatric Assessment (RGA) (Morley, 2017) is a tool that can be used in most healthcare settings. Designed as a rapid screening, the validated RGA assesses frailty, sarcopenia, anorexia, cognitive function, and advance care planning. Developed in 2015 through the Geriatric Workforce Enhancement Program (GWEP), 3,489 students and 5,643 faculty and practitioners have been trained in its use and have completed 10,881 RGAs in case-finding, screening, nursing home, PACE, and hospital and residential settings. Non-population-based findings show higher-then-national prevalence in all four health condition areas across settings: frailty (n=3,140; 30%), sarcopenia (n=4,458; 42.1%), weight loss risk (n=3,012; 28.4%), and cognitive impairment (n=2,509; 23.7%). Only 34.8% of the total sample had completed advance care plans. Data comparing results by gender, age, race/ethnicity, and setting will be presented along with strategies for curricular and practice integration.

scholarly journals Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026921 ◽  
Author(s):  
Neil H Chadborn ◽  
Claire Goodman ◽  
Maria Zubair ◽  
Lídia Sousa ◽  
John R F Gladman ◽  
...  
Keyword(s):  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Care Home ◽  
Realist Review ◽  
Care Homes ◽  
Care Plan ◽  
Cochrane Library ◽  
Care Planning ◽  
Programme Theory ◽  
Term Care

ObjectivesComprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes.DesignRealist review.SettingCare homes.MethodsThe review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute.Results130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care.ConclusionThe programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work—this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings.Trial registration numberCRD42017062601.

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