Despite government claims that this winter is no worse than any other for the NHS, it certainly seems to be. Wednesday’s Guardian reported that more than 20 hospitals had declared a black alert and that “patient safety was no longer assured”. The situation seems desperate.
As the Guardian identifies, part of the problem is not being able to discharge elderly patients if there is insufficient social care support – one consultant we spoke with yesterday estimated that as many as 10% of the beds in his hospital are occupied with elderly people awaiting discharge. But discharge is not the only problem. According to some of the consultants in Trusts we work with, there is also the issue of whether elderly patients should be admitted at all in certain circumstances.
As another consultant put it, “There is no doubt that many of the elderly patients we see require admission. They are very frail and very sick and hospital treatment is necessary. But there are a number of patients for whom hospital is simply not the right choice. To quote an extreme, in the past couple of days I have seen two elderly patients who were admitted close to the end of their lives. Both sadly died within a few hours of admission. I question whether the decision to admit was right for them, I suspect it wasn’t”.
There are also problems with elderly patients being admitted when better pathways exist: “For example, we see very anaemic patients who are in need of a transfusion. We have a day unit for this that the patient can attend, without being admitted, and it is better for both the patient and the NHS. But many people who deal with the frail elderly, such as care home staff, don’t know about this”.
“If you aren’t a clinician and you aren’t confident in deciding on a course of action, calling 999 may seem like the best option for the patient. What happens then, though, is that, instead of a trip to a day unit, an ambulance is called, the patient is assessed in the EAU from where they will likely go on to stay in a ward. There are often many alternative options available, including domiciliary visits by myself or my colleagues if necessary”.
Our own data from Consultant Connect projects supports the idea that elderly admissions can be avoided – 12% of Advice & Guidance calls from GPs to specialist Elderly Care consultants have resulted in the patient avoiding an admission (a further 45% of calls have avoided an unnecessary elective referral).
“In most cases it is the simple sharing of information about a patient that is key. The person we speak with might be the manager of a care home, a community nurse, a GP or a paramedic. As long as we can get the information we need, we can help make a decision that will hopefully result in the best possible outcome for the patient”.
To arrange a call to discuss how a telephone Advice & Guidance service might work for GPs and other workers dealing with the frail elderly in your area, please call us on 01865 261467 or email us at firstname.lastname@example.org