Optimising the Comprehensive Geriatric Assessment

Authors: John Brennan , Sara O’Kelly, Jane Finucane, Sarah Cosgrave, Diarmuid O’Shea

Abstract Introduction: Carew House Day Hospital is an outpatient assessment unit for patients aged 65 years and over and is operated by the Medicine for the Elderly service in St. Vincent’s University Hospital (SVUH). Patients attending Carew House undergo multidisciplinary Comprehensive Geriatric Assessment (Medical, Nursing, Physiotherapy, Occupational Therapy and Social Work) with further access to Speech and Language Therapy, Dietician and Smoking Cessation services as required. The service assesses approximately 600 new patients annually.The National Clinical Programme for Older People advocates a Comprehensive Geriatric Assessment (CGA) of frail older patients as a means to increase independence in the home and reduce inappropriate admissions to nursing homes.Short Description of Practice Change Implemented: Deficiencies in the CGA were identified and discussed at a meeting of the Day Hospital Management involving medical, nursing and allied health staff. These deficits were demonstrated through an initial pilot and retrospective review of patients assessed in the Day Hospital.It was recognised that additional resources and staff for the Day Hospital would not be an available option to alleviate this problem.Once deficits in the CGA were identified and outlined, staff were empowered to engage with the change process immediately in order to develop improvement solutions.Aim and Theory of Change: The aim of this project was to empower members of the multidisciplinary team (MDT) to generate efficiencies within the service and to identify areas where the CGA could be streamlined. In December 2014, the following interventions were implemented:A new vetting process for patient referrals to ensure appropriate MDT members would be available on the date of assessmentNomination of designated nurse leader and senior clinician in the absence of regular staffAn additional and timely referral pathway for physiotherapy and occupational therapy assessment using pre-existing additional community servicesAlternative access routes for medical social work input involving redesign of the referral pathwayTargeted Population and Stakeholders: This included all patients assessed in Carew House Day Hopsital and all members of the MDT.Timeline: September 2014 – April 2015Highlights: Having a Consultant’s clinical opinion directly available for each patient increased from 79% to 88%. The presence and input of a Nurse Manager on the day of assessment increased from 30% to 99%. Completion of Physiotherapy and Occupational Therapy assessment for patients increased from 65% to 73%, and 96% to 99% respectively.In addition to these improvements in the CGA, systems were implemented to ensure that a senior clinical opinion (Registrar or Consultant) was available at all times via telephone and a Deputy Nurse Lead was appointed in the absence of a Nurse Manager. An additional 15% of patients received Physiotherapy assessment via the newly implemented alternative referral pathway.Comments on Sustainability: It is recognised that while this suite of interventions has resulted in progress, our service is in constant need of review and regeneration in order to continue to improve for our patients.Comments on Transferability: This change process engaged staff across the MDT and highlighted that positive change in a service is achievable through improving efficiency and redesigning processes, without budgetary expansion. This model is transferable.Conclusions: Changes in Carew House Day Hospital resulted in improvements in the constituents and overall quality of the CGA for our catchment community.Discussions: While this project resulted in some improvement, the main barrier encountered was in recognising the deficits in our service that required change.Lessons Learned: Resource limitations should never stand in the way of improvement!

Keywords:

medicine for the elderly, comprehensive geriatric assessment, staff engagement, quality improvement, resource limitations

How to Cite:

Brennan J, O’Kelly S, Finucane J, Cosgrave S, O’Shea D. Optimising the Comprehensive Geriatric Assessment. International Journal of Integrated Care. 2017;17(5):A538.

DOI: http://doi.org/10.5334/ijic.3858Published on 17th October 2017