scholarly journals 162 An Audit of Comprehensive Geriatric Assessment in the Southern Trust Acute Care at Home Service

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Ann McCann ◽  
Patricia McCaffrey ◽  
Deborah Toal

Abstract Background The population is ageing. Acute Care at Home (AC@H) is a consultant led multidisciplinary team, providing acute non-critical care to our older population, preventing hospital admissions and promoting a better quality of life and supporting them to live independently for longer. A recent Cochrane review shows that older people who receive Comprehensive Geriatric Assessment rather than routine medical care after admission to hospital are more likely to be living at home and are less likely to be admitted to a nursing home at up to a year after hospital admission. Methods One-hundred patient charts were selected at random who had been under the AC@H team between 2016 and 2018. The nursing and medical assessments were reviewed to assess how well Comprehensive Geriatric Assessment was being carried out. The domains selected for audit are shown in the results table Results The domains were assessed appropriately as follows in percentages - Dementia 93%, Delerium 85%, Depression 6%, Falls, 99%, Fractures/Osteoporosis: 27%, Medication/Polypharmacy: 100%, Pain: 91%, Nutrition: 98%, Skin: 93%, Incontinence: 94%, Advanced Care Planning: 39%, Visual Acuity: 7%, Social Support: 99% Conclusion Whilst some areas of Comprehensive Geriatric Assessment are achieved adequately, others are not. Our electronic assessment did not include a Geriatric Depression Score. Although pain was frequently assessed, again a score was not always used. Other areas for improvement include visual acuity, fractures and osteoporosis and advanced care planning The results of this audit have been presented to the team, adjustments have been made to our electronic assessments so that we can record and capture this data better. There will be a reaudit in 6 month’s to evaluate improvement.

Author(s):  
Guillaume Deschasse ◽  
Frédéric Bloch ◽  
Elodie Drumez ◽  
Anne Charpentier ◽  
Fabien Visade ◽  
...  

Abstract Background There is a need for a mortality score that can be used to trigger advanced care planning among older patients discharged from acute geriatric units (AGUs). Objective To develop a prognostic score for 3- and 12-month mortality after discharge from an AGU, based on a comprehensive geriatric assessment, in-hospital events, and the exclusion of patients already receiving palliative care. Methods DAMAGE is a French multicentre, prospective, cohort study. The broad inclusion criteria ensured that the cohort is representative of patients treated in an AGU. The DAMAGE participants underwent a comprehensive geriatric assessment, a daily clinical check-up, and follow-up visits 3 and 12 months after discharge. Multivariable logistic regression models were used to develop a prognostic score for the derivation and validation subsets. Results 3509 patients were assessed and 3112 were included. The patient population was very older and frail or dependant, with a high proportion of deaths at 3 months (n=455, 14.8%) and at 12 months (n=1014, 33%). The score predicted an individual risk of mortality ranging from 1% to 80% at 3 months and between 5% and 93% at 12 months, with an area under the receiving operator characteristic curve in the validation cohort of 0.728 at 3 months and 0.733 at 12 months. Conclusions Our score predicted a broad range of risks of death after discharge from the AGU. Having this information at the time of hospital discharge might trigger a discussion on advanced care planning and end-of-life care with very old, frail patients.


Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam

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.


2017 ◽  
Vol 46 (Suppl_3) ◽  
pp. iii1-iii12
Author(s):  
Ann McCann ◽  
Patricia McCaffrey ◽  
Gail Nicholson ◽  
Eamon Farrell

2001 ◽  
Vol 49 (8) ◽  
pp. 1123-1125 ◽  
Author(s):  
Bruce Leff
Keyword(s):  

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Deborah Toal ◽  
DrPatricia McCaffrey

Abstract Background The Aim of the Acute Care at Home Team is to provide acute care to over 65's in the patient's own home, providing assessment and treatment of acute conditions such as pneumonia, urinary sepsis and heart failure. It is a multidisciplinary team that works together to streamline services to enable a patient to stay safely in their own home. A full comprehensive geriatric assessment is carried out in all patients to help improve patient outcomes. The patients have full access to in patient services such as scans, and x-rays. All blood tests are treated as urgent to ensure the patient is in no way disadvantaged by being treated by acute care at home compared with hospital care. The aims and objectives are to explore patient and family experiences and identify any areas for improvement. Methods A service users and carers experience Questionnaire (N=31) was used to gain insight into how satisfied the patient or family were with the service and what the experience was like having the team come into their home. Results Patient satisfaction with this Acute Care at Home Team was reported at 100%. Patients were happy with the care they received, 100% of patients were happy with staff's knowledge of their condition and treatment plan. All of the respondents stated they would both recommend the service and use it again. The qualitative responses were in keeping with 100% satisfaction in that they were positive in nature. Conclusion This service evaluation has shown that patient and carer experience of this Acute Care at Home Team is a positive one, with 100% satisfaction levels. There are some small areas to be improved upon, however the results show this service is providing the over 65 population with a good experience of being treated at home as an alternative to hospital care when acutely unwell.


2021 ◽  
Vol 35 (6) ◽  
pp. 281-283
Author(s):  
Kevin Worth ◽  
Laure Lisk ◽  
Elizabeth Ann Scruth
Keyword(s):  

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