Acute ward care
Precise models of care delivery for acute inpatient care for older people vary according to local arrangements; however some key principles can be applied.
Following admission to hospital with an acute illness, an older person is more likely to be alive and living in their own home 6 months after the event if they receive a comprehensive geriatric assessment by a specialist team in a specialist geriatric medicine ward. This team needs to include geriatricians and their associated junior staff, in addition to skilled nursing staff and allied health professionals, including physiotherapists and occupational therapists. In some areas, admission is direct to a ‘frailty unit’; in others, older people are transferred to a specialist ward from a general admissions unit.
Provision should exist for patients newly admitted to a geriatric medicine ward to have a consultant review as soon as possible following transfer; a new medical review of an older person living with frailty and multimorbidities will take more time than a similar review of a younger person with a single organ condition, and job planning should take this into account. The practice of a daily ‘board round,’ consisting of a brief, targeted MDT discussion of each patient on a ward is also becoming regarded as good practice to ensure appropriate medical treatment and minimise internal and external delays. Communication with patients and their families or carers is an essential part of the work of a geriatrician and time to do this effectively should not be underestimated.
For an inpatient workload of 20 acutely unwell older adults, assuming 10 admissions/discharges per week and two consultant-led ward rounds, approximately three PAs will be needed to carry out the above duties and associated administration. This is an estimate with multiple variables.
There should be provision within every department for prospective cover of ward patients to allow annual and study leave to be taken without adverse effect on patient care.