Interface geriatrics

Simon Conroy Head of Service/Senior Lecturer, Geriatric Medicine University Hospitals of Leicester Speciality clinical director, Leicestershire Partnership NHS trust

Why this is important

• Evidence-based, educational solutions – For frail older people • Integrated whole systems perspective – ‘Team without walls’ – Aligned to NHS priorities • Holistic, generalist approach – Interdisciplinary team working

What we did…

• Vertically integrated services for frail older people • Focussed comprehensive geriatric assessment, including social care – At and across the interfaces; – Coordinated and communicated • Horizontal integration (emergency department (ED) and geriatrician (GER)) • Whole system, collaborative leadership

How we did it

Intermediate care Bed-based rehabilitation/ reablement Liaison Frail older person in crisis SPA – clinical discussion MDT Triage Trajectory Transfer Elderly frail unit (EFU)/Frail Older People’s Advice & Liaison Service (FOPAL) Specialist care In-patient CGA

Bed-based rehabilitation/ reablement Liaison Intermediate care Frail older person in crisis SPA – clinical discussion Multi disciplinary team (MDT) Triage Trajectory Transfer Elderly frail unit (EFU)/Frail Older People’s Advice & Liaison Service (FOPAL) Specialist care In-patient Comprehensive Geriatric Assessment (CGA)

ED performance 2010-12: people 85+

How we kept it going

• Whole system focus on frail older people – Clinical Commissioning Groups (CCGs), psychiatry, social care • Cost savings – Acute £0.5M

– Community £0.75M

• Profile and capacity raising – Fellowship in Emergency Geriatric medicine – GP fellowship in Interface Geriatrics – Emergency medicine curriculum changed – IHI fellowship, Harvard

How we spread the message Dissemination

• External visits • Silver Book • ED curriculum • RCP acute care toolkit • BGS activity • Publications • Today!

Research

• Evaluation of interface geriatrician role Programme grant of emergency care of older people • Health service & delivery research (HSDR) grant on acute care of older people

Summary

• Urgent care = older people • Whole system solutions required – Vertically integrated – Holistic & interdisciplinary – Underpinned by robust communication and cooperation

Contact details

http://www2.le.ac.uk/departments/cardiovascular sciences/people/conroy/the-silver-book/the-silver book/ or [email protected]

Thanks!