Age and Ageing 2014; 43: i1–i18 doi: 10.1093/ageing/afu036
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Clinical effectiveness
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REDUCING INAPPROPRIATE ADMISSIONS OF OLDER PEOPLE INTO ACUTE HOSPITALS: THE ROLE OF A RAPID ACCESS CLINIC IN A COMMUNITY HOSPITAL
D. Y. Koduah1, D. Inegbenebor1, J. Ambepitiya2, M. Khan1, F. Mlinaku1, M. Shariq1, F. Adusa-Amankwa1, R. Ehsan1, S. Bansal1, G. B. Ambepitiya1, S. Khan1, M. Safdar1 1 St Margaret’s Hospital, Epping, West Essex 2 University College, London (Medical Student) Background: An increasing number of admissions of frail older people attending emergency departments or accessing urgent care are reported to be unsafe, inappropriate and
associated with increased costs. The multiple co-morbidities of these patients could often be managed in the community. However the current community care models have shown only modest impact and cost effectiveness in reducing Acute District General Hospital (DGH) admissions. (Silver Book, British Geriatrics Society, 2012). Innovation: The Rapid Assessment Clinic (RAC) in St Margaret’s Hospital (SMH) Epping, West Essex, a semi-acute community hospital for older patients, is a doctor-led, one-stop, multidisciplinary team assessment unit. It operates within normal working hours. Referrals are accepted from General practitioners, Paramedics, community case managers, district nurses, mental health team, self and family. The aim of the unit is to prevent inappropriate referrals or admissions into acute hospitals. Evaluation: Retrospective analysis of data, collected over 46 months of all 1880 patients seen in RAC, was done. Fifty-six percent were discharged back home or to previous care settings, 29% were admitted into community hospitals and only 15% were referred to the nearest acute hospital. The mean waiting time for a patient before review by a doctor was 28.3 minutes whilst about 93% of patients were seen within 60 minutes. Conclusion: Our analysis suggests that RAC in a local community hospital could provide an ideal multidisciplinary team setup to address varied multi-pathological needs of an older person. It also has the advantage of being ‘care closer to home’ with patients being seen quicker in a more appropriate environment compared to Accident and Emergency.
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