Great geriatric care
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Tom Downes discusses improving geriatric care in Sheffield, England. He outlines key details about the city and hospital demographics. The document then describes initiatives taken by the hospital to improve outcomes for elderly patients, such as opening a frailty unit which reduced length of stay by over 4 days and in-hospital mortality by 13%. It also discusses implementing a "discharge to assess" model which led to a 30% reduction in length of stay and inpatient falls. The initiatives have helped reduce overall length of stay for patients over 65 by continuously discovering improved processes through a quality improvement approach.
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Kevin Fenton
The document discusses the opportunities for prevention to address non-communicable diseases in England. It outlines that while life expectancy has increased, levels of ill health have not improved at the same rate. The Five Year Forward View calls for a radical upgrade in prevention. The document then discusses moving beyond the Five Year Forward View to implementation, including interventions to improve health outcomes and save money, sustainability and transformation plans, and building workforce leadership and capabilities for prevention.
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Great geriatric care
- 1. Discovering great geriatric care Version 3 13 August 2014 Tom Downes Consultant Geriatrician Clinical Lead for Quality Improvement, Sheffield Teaching Hospitals The Health Foundation / IHI Quality Improvement Fellow 28th September 2016
- 2. GREAT CARE IS DISCOVERED, NOT DECIDED Steve Spear, MIT
- 3. Sheffield: • Population of 580k and growing • Europe’s greenest city • 43% of households vulnerable to significant financial stress • Single vertically integrated adult provider • Single Social Care provider • Single Care Commissioning Group Sheffield Teaching Hospitals: • One of largest FTs in England - £1bn turnover and 16k staff • Large tertiary provider – around one-third of activity
- 6. George
- 7. A complex system problem
- 10. The Big Room in Action Physiotherapist gives an account of the test of change to get a patient home on the day they were discharged by the GSM consultant Senior registrar General Manager For Medicine GSM Matron Service Improvement Social Services Manager Community Services manager Physiotherapist Secretary Discharge Liaison
- 11. Let me introduce ‘George’ •82 years old •Lives independently and wants to continue doing so •Widowed 5 years ago •Has mild dementia •Daughter lives locally •Losing weight + poor mobility PDSA tests of moving from ‘post take’ to ‘on take’
- 13. Frailty Unit
- 14. Outcome measure: 34% increase in discharge within 1 day Frailty Unit opens
- 15. Length of stay for frailty unit patients reduced by more than 4 days Frailty Unit opens
- 16. In-hospital mortality dropped by over 13% Frailty Unit opens
- 18. D2A starts Reduction of 6 days waiting on implementing D2A
- 20. D2A starts 30% reduction of inpatient falls on pilot ward
- 21. In last one year >10,000 patients discharged to home support in 1.2 days compared with 5.5 days
- 22. Whole system reduction in LoS of patients aged >65y
- 23. “It’s changed the way we think.”
- 24. Future • Frailty Unit is continuing to discover improved process and hitting highest ever discharge rate • Purpose designed Frailty Unit opens 2017 to enhance efficiency and care experience • Big Room is currently testing D2A for more complex patients
- 25. How do we get better at making patients better? Discovery.
- 26. @sheffielddoc Thank you Tom.Downes@sth.nhs.uk Version 3 13 August 2014