In July 2019, The Royal College of Emergency Medicine published its Winter Flow Report for 2018/19. The report states that, between 2011-2012 and 2017-2018, there was a “477% increase in the number of patients stranded in an Emergency Department [in England] for more than 12 hours.” This is a worrying trend which “can be observed in each of the nations of the UK.” Read on to find out how this is affecting Elderly Care and how Telephone Advice & Guidance can address it.
According to The Winter Flow Report 2018/2019, one of the issues facing the NHS and those aiming to decrease A&E waiting times is that “the number of elderly and otherwise vulnerable patients has increased while the number of beds to put them in has decreased by just over 7,000.” This poses multiple problems as, not only do patients have to wait longer for emergency care, but according to some of the consultants in Hospital Trusts we work in, there is also the question of whether elderly patients should be admitted at all in certain circumstances. Hospital admissions are full of risk; infection, falls, deconditioning are all common in hospital.
Feedback suggests that giving GPs access to rapid Advice & Guidance from a consultant can allow for better care without a stressful trip to A&E. In addition, in the case of the elderly, it could even be a life-saver.
Our performance benchmark report highlights this with 64% of GP calls via Consultant Connect to Care of the Elderly resulting in a hospital trip being avoided.
Here’s a case from Dr Anne Mullin, a GP Glasgow:
An 88-year-old patient was “found to be profoundly hyponatraemic (causing bradycardia and dizziness).” He had “recently undergone tests to investigate retinal artery occlusion.” Urea and Electrolyte results came back late from the lab. Using Consultant Connect’s Phone Advice & Guidance service, Dr Mullin was able to immediately contact a consultant at Queen Elizabeth University Hospital to discuss the follow up options.
The patient was “seen at the Department for Medicine for the Elderly the following day where appropriate investigations were performed, and his medication was reviewed.” Dr Mullin says that “this avoided a late evening admission as [she] could discuss the patient’s current functional status with the consultant planning the follow up (which was very prompt).” As a result of using Phone Advice & Guidance, an “unnecessary admission” was avoided.
Dr Catherine Barnes, Consultant Geriatrician in Sunderland, shares her experience:
The Recovery at Home Team were concerned about an elderly patient, living on her own at home. She was known to have Chronic obstructive pulmonary disease, but had recently become more breathless. The patient complained of weight loss and a poor appetite and explained she had been collapsing at home. She had recently been seen in the Emergency Department, but they felt that she wasn’t improving.
“We arranged an urgent Outpatient Clinic appointment, which she attended. We were able to assess her, with access to her medical records and previous investigations. Blood tests, an ECG and lying and standing Blood Pressure were checked and advice with regards to changes to her medication was given. We were able to liaise with other services involved in her care.
This enabled the patient to get the assessment and support she needed without an emergency admission.”
More case studies where A&G benefitted elderly patients:
To discuss how Enhanced Advice & Guidance might work for GPs and other clinicians dealing with the frail elderly in your area, please call us on 01865 261467 or email us at firstname.lastname@example.org.