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dc.contributor.authorSilvester, K.M.*
dc.contributor.authorMohammed, Mohammed A.*
dc.contributor.authorHarriman, P.*
dc.contributor.authorGirolami, A.*
dc.contributor.authorDownes, T.W.*
dc.date.accessioned2016-10-14T15:48:10Z
dc.date.available2016-10-14T15:48:10Z
dc.date.issued2014-07-01
dc.identifier.citationSilvester KM, Mohammed MA, Harriman P et al (2014) Timely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources. Age and Ageing. 43(4): 472-477.
dc.identifier.urihttp://hdl.handle.net/10454/9937
dc.descriptionNo
dc.description.abstractHospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients. We undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources. Prospective systems redesign study over 2 years. The Geriatric Medicine Directorate in an acute hospital (Sheffield Teaching Hospitals NHS Foundation Trust) with 1920 beds. Older patients admitted as emergencies. Diagnostic patient flow analysis followed by a series of Plan Do Study Act cycles to test and implement changes by a multidisciplinary team using time series run charts. 60% of patients aged 75+ years arrived in the Emergency Department during office hours, but two-thirds of the admissions to GM wards were outside office hours highlighting a major delay. Three changes were undertaken to address this, Discharge to Assess, Seven Day Working and the establishment of a Frailty Unit. Average bed occupancy fell by 20.4 beds (95% confidence interval (CI) -39.6 to -1.2, P = 0.037) for similar demand. The risk of hospital mortality also fell by 2.25% (before 11.4% (95% CI 10.4-12.4%), after 9.15% (95% CI 7.6-10.7%) which equates to a number needed to treat of 45 and a 19.7% reduction in relative risk of mortality. The risk of re-admission remained unchanged. Redesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources.
dc.relation.isreferencedbyhttp://dx.doi.org/10.1093/ageing/aft170
dc.subjectAged; Delivery of health care; Emergency service; Female; Frail elderly; Geriatric assessment; Great Britain; Hospital mortality; Humans; Length of stay; Longitudinal study; Male; Patient readmissions; Prospective studies; State medicine; Time-to-treatment; Treatment outcome; Efficiency; Frailty; Improvement science; Mortality; Older people; Systems thinking
dc.titleTimely care for frail older people referred to hospital improves efficiency and reduces mortality without the need for extra resources
dc.status.refereedYes
dc.typeArticle
dc.type.versionNo full-text available in the repository


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