GSCOP will deliver a first-class blended modular training programme (a combination of class-based and online learning) to ensure that frail and older patients are cared for by appropriately trained hospital staff, equipped with the skills, knowledge, confidence and understanding of the specific clinical needs of individual frail and older patients. It is anticipated that this training will help multi-professional staff members learn and share knowledge in a team environment, and help bring about an increased awareness as well as facilitate the delivery of Comprehensive Geriatric Assessment (CGA) to frail and older people cared for in non-specialist areas.
The problemWith an ageing population, the number of people in our society with health or care needs is rising. This has altered the very nature of our health and care services, with older people now the biggest users. This trend holds new responsibilities for the NHS in helping older people stay healthy, active and independent for as long as possible.
Undergraduate medical curricula tend to give little emphasis to the specific needs of frail and older patients, while auxiliary staff members receive no formal training on the subject. Nottingham University Hospitals’ SCOPES (Systematic Care for Older People in Elective Surgery) clinic provides CGA for pre-operative frail and older people undergoing elective surgery. However, no such system currently exists for patients admitted as an emergency in general surgical specialties.
As high quality care of frail elderly people is challenging, this initiative will deliver a team-learning educational package to surgical and non-surgical staff, enabling them to share knowledge, ideas and expertise. It will enhance their understanding of the specific needs of older patients in non-specialist areas, and increase their confidence in caring for frail and older people while helping them identify the most common medical problems of these patients.
Proposed education interventionThe project aims to give Trust staff the skills and knowledge to carry out CGA, thereby improving clinical outcomes and patient experience for frail and older people. CGA is a multidimensional and interdisciplinary diagnostic process designed to determine a frail and older person’s medical conditions, mental health, functional capacity and social circumstances, in order to develop a coordinated and integrated plan for treatment, rehabilitation, support and long term follow up.
The educational intervention consists of 12 modules, which will provide staff with a comprehensive grounding in the care of frail and older people. Subjects covered include delirium, prescribing, falls prevention, continence and dementia. Each online module will be complemented with a classroom session to enable participants to consolidate what they have learnt in the context of team learning.
The educational package aims to be a model for high quality skills training for surgical staff looking after frail and older patients. It will initially be delivered to staff on two wards at Nottingham City Hospital between January and April 2014. The intervention will be formally evaluated for effectiveness in May 2014.
Benefit to Patients• Increase in patient satisfaction with the service
• Greater functional independence and reduced dependency on institutional care for frail and older patients
• Reduction in length of stay in hospital
• Reduction in hospital readmission rate
• Reduction in 30 day mortality rate
• Reduction in falls
• Reduction in the rate of patients developing acute post-operative kidney disease
• Reduction in delays to surgery
Benefits to service• Equips ward staff with appropriate assessment and management skills in the care of older people, leading to an improvement in understanding and communication and increased job satisfaction
• Development of a method for identifying potential co-morbidity, disability and frailty as independent markers of risk in older patients
• Reduction in length of stay and unnecessary admissions or appointments will support Trust to achieve 4 hour emergency department target
Productivity and impact• Reduced length of stay and readmission rates resulting in cost avoidance and bed savings, allowing more patients to be treated with the available resources
• Increased task sharing and team communication improves productivity in the Trust
Dr Rob Morris, Pathway Lead Clinician for Older People, Nottingham University Hospitals NHS Trust
Donny Kingsley Okoh, Project Manager, Nottingham University Hospitals NHS Trust