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Improving general hospital care for people with dementia: why, how and with whom? Nye Nye Harries
Improving general hospital care for
people with dementia:
why, how and with whom?
Nye
Nye Harries
Harries
DHDH SWSW
Dementia care in acute hospitals Dementia care in acute hospitals Royal Royal College College of of
Dementia care in acute hospitals
Dementia care in acute hospitals
Royal
Royal College
College of
of Psychiatrists
Psychiatrists 11 identified that on
identified that on
average
average inin aa 500-bed
500-bed district
district hospital:
hospital:
330
330
beds will be occupied by older people
beds will be occupied by older people
220
220
of these will have a mental health disorder
of these will have a mental health disorder
 of
of which
which 102
102 will
will have
have dementia
dementia
(depression
(depression and
and delirium
delirium form
form most
most of
of the
the
remainder)
remainder)
1.
1.
Who Cares Wins: improving the outcome for older people admitted to a general
Who Cares Wins: improving the outcome for older people admitted to a general
hospital
hospital,, Royal
Royal College
College of
of Psychiatrists,
Psychiatrists, 2005
Who Who care care wins wins onon outcomes outcomes Research studies cited in the RCP report
Who
Who care
care wins
wins onon outcomes
outcomes
Research studies cited in the RCP report highlight a
Research studies cited in the RCP report highlight a
range of important outcome measures for this group:
range of important outcome measures for this group:
increased
increased mortality
mortality
longer
longer lengths
lengths of
of hospital
hospital stay
stay
greater
greater rate
rate of
of institutionalisation
institutionalisation inin aa care
care home
home
following
following their
their acute
acute stay
stay
National Dementia Strategy Objective 8: National Dementia Strategy Objective 8: Improved quality of care in general
National Dementia Strategy Objective 8:
National Dementia Strategy Objective 8:
Improved quality of care in general hospitals
Improved quality of care in general hospitals
To improve the quality of care and health outcomes
To improve the quality of care and health outcomes
for
for people
people with
with dementia
dementia
To provide a comprehensive mental health
To provide a comprehensive mental health
assessment and advice on planning of care.
assessment and advice on planning of care.
Develop
Develop explicit
explicit care
care pathways
pathways
Senior
Senior clinician
clinician lead
lead
Includes community hospitals too!
Includes community hospitals too!
Financial & performance impact Financial & performance impact NAO estimate excess cost over £6 million pounds
Financial & performance impact
Financial & performance impact
NAO estimate excess cost over £6 million pounds
NAO estimate excess cost over £6 million pounds
per per year year per per acute acute hospital. hospital.
One SW review site (2009): data showed that FNOF
One SW review site (2009): data showed that FNOF
with dementia diagnosis had 25% longer stay in
with dementia diagnosis had 25% longer stay in
hospital hospital
Dementia Dementia isis aa know know risk risk factor factor for for delayed delayed transfers transfers
Typical problems in the acute setting.. Typical problems in the acute setting Recognition Recognition of of
Typical problems in the acute setting..
Typical problems in the acute setting
Recognition Recognition of of dementia. dementia.
Majority unknown to mental health services.
Majority unknown to mental health services.
Crisis Crisis admissions. admissions.
Discharge planning, limited options for
Discharge planning, limited options for
rehabilitation, intermediate care, step down beds
rehabilitation, intermediate care, step down beds
toto facilitate
facilitate discharge
discharge home.
home.
Poor Poor risk risk assessment assessment false false assumptions assumptions
Problems ... Problems ... Poor recognition and care, with higher risks Poor recognition and care, with
Problems ...
Problems ...
Poor recognition and care, with higher risks
Poor recognition and care, with higher risks
inin hospital
hospital of
of ::
– Malnutrition
Malnutrition && dehydration
dehydration
– Inadequate
Inadequate pain
pain relief
relief
– Over
Over sedation
sedation
– Poor
Poor end
end of
of lifelife care
care
Improving general hospital care : Improving general hospital care : key key challenges challenges Seeing dementia/cognitive
Improving general hospital care :
Improving general hospital care :
key
key challenges
challenges
Seeing dementia/cognitive impairment as a
Seeing dementia/cognitive impairment as a
whole Trust issue, not just elderly care
whole Trust issue, not just elderly care
Securing
Securing executive
executive sign-up
sign-up
Making the link with the Trust “performance”
Making the link with the Trust “performance”
agenda
agenda –– LoS.
LoS. Demonstrating
Demonstrating the
the value
value of
of
effective
effective pathways, input of liaison .
pathways, input of liaison .
Ensuring
Ensuring good
good data
data –– egeg clinical
clinical coding
coding
Breakdown of RUH Inpatient Bed Breakdown of RUH Inpatient Bed Days by age cohort, 2008 /
Breakdown of RUH Inpatient Bed
Breakdown of RUH Inpatient Bed
Days by age cohort, 2008 / 09
Days by age cohort, 2008 / 09
Age 0-15
6%
Age 80+
Age 16-64
38%
28%
Age 65-79
RUH inpatient bed days by age for RUH inpatient bed days by age for Surgery/Ortho/MAU/Gen Surgery/Ortho/MAU/Gen
RUH inpatient bed days by age for
RUH inpatient bed days by age for
Surgery/Ortho/MAU/Gen
Surgery/Ortho/MAU/Gen Med:
Med: 2008/09
2008/09
80+
Number
65-79
of
Bed
16-64
Days
0-15
General
Orthopaedics
A&E
General medicine
Surgery
What levers could help you? What levers could help you? Extra focus on LoS reduction in
What levers could help you?
What levers could help you?
Extra focus on LoS reduction in 2010/11
Extra focus on LoS reduction in 2010/11
Sharing data from the new national audit
Sharing data from the new national audit
C-QUIN, C-QUIN, with with commissioners commissioners
Trust Trust Quality Quality Accounts Accounts
Sharing Sharing data data from from the the new new audit audit
Patient Related Outcome Measures (PROMs) Patient Related Outcome Measures (PROMs)
Patient Related Outcome Measures (PROMs)
Patient Related Outcome Measures (PROMs)
Who are your potential allies? Who are your potential allies? Director of Nursing & Chief Executive
Who are your potential allies?
Who are your potential allies?
Director of Nursing & Chief Executive
Director of Nursing & Chief Executive
LINKs LINKs
Council Overview & Scrutiny
Council Overview & Scrutiny
Committee Committee
Trust Trust Non-Executives Non-Executives

Alzheimer's Society

Alzheimer's

Society

Commissioners Commissioners
Commissioners
Commissioners
www.southwestdementiapartnership.org.uk
.. Thank Thank you you nye.harries@dh.gsi.gov.uk nye.harries@dh.gsi.gov.uk
..
Thank
Thank you
you
nye.harries@dh.gsi.gov.uk
nye.harries@dh.gsi.gov.uk