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Frailty unit and Front door Geriatrician
Better collaboration and relationship with onward care/ community
Getting back to have time for teaching and training students and juniors
improving clinic effectiveness - using local clinics, reducing DNA rates, appropriate referrals
Community geriatrician working closely with local GP MDTs

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AHP's (OT/physio) hours extended in ED so able to get patients up, on their feet and discharged. On-call OT service and extended hours of D2A to catch patients on discharge. Scope/collect data for potential benefits (Penchord links).

AHP (physio) input increased in MAU type setting to support HCA's/Nurses/Therapy Techs in getting frailty patients up and sitting out. Too many frail patients spend initial days of admission in bed.

Core assessments and plans in place and staff to deliver especially mobility, nutrition, prevention of harms. AHP's linking with HCA's.

Bay Watch. All staff to implement and participate. Notes trolley in bays, observe patients, intervene to keep safe.

Keep patients mobile, active, engaged on wards.

On discharge, more access to 24 hours care at home for high risk patients to prevent readmission (could scope/collect data on this and the cost of readmission versus cost of 24 hour care). D2A to support and problem solve in home environment.

Third party providers in community to assist with discharge, social engagement and maintaining people at home. How do third parties feedback problems and who do they link with to solve them?

Pro-active communities keeping frail people safe, active and engaged at home. Forward planning in place for next step of persons life if increasingly frail.

Nick Hudson, physio

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Bringing a bespoke service to patients by helping with dishcharge planning medication review medicine management possibly having a prescribing pharmacist on team to tailor and adjust medicines in close cooperation with medical staff and follow up links in community pharmacy.

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Listening to and empowering staff - they know what the problems are and the solutions - why are we depending on external people to tell us what is wrong?
Matching staff numbers and workload - the current "system" is unsustainable for medicine nursing and therapies.
Improve working with onward care and social care - the current lack of trust means that we are duplicating work and delaying essential patient care. Discharge planning from day one or pre-admission rather than waiting until "medically fit".
Better front door working - we were doing well, but this seemed to be abandoned due to service and financial pressures. we could relieve pressure on stroke/ MAU and orthogeries by proactively seeing patients in ED as well as improving front door turnaround.
Fragility fracture pathway that is agreed across divisions - the current labelling of fractures as "medical" does the patients a big disservice.
Matching the clinical needs of the patients to the bed that they are assigned to - currently the bed situation dictates clinical care.
Defining the function of WCH - it has fantastic facilities and staff which are wasted looking after patients who are waiting for placement of a care package - rehab stroke care and/ or rehab orthogeries/ rapid access  clinics would seem sensible.
Clinic demand and capacity matching. Choose and Book doesn't respond to variations in in demand and sometimes books elderly and frail patients into clinics that are not close to where they live.
Better triage of "TIA" patients to make sure non TIA patients are directed to other services.
Staff development - we need to provide opportunities for medical, nursing, admin and AHP staff to develop their skills outside of "normal" career pathways to support perm.anent employees to enhance patient care into the future
Mark

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Geriatrics at front door
Enough colleagues to deliver high quality student teaching.
Joint care of all fragility fractures on Trauma unit - with appropriate consultant and therapy staffing.
An OT on Tintagel.

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We currently receive a very high level of training despite being part of a pressured department. Continue to ensure trainees have protected educational opportunities (which we do).  Help ensure educational opportunities for all geriatric junior doctors, ie ensure CMT trainees get to clinic. The high level of training given here will help increase local recruitment to fill department vacancies and hopefully build a department of the future to help bring all these ideas together.

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Collaborative working with colleagues in health and  social care. Agreed standards, policies and improved IT links.

Comprehensive assessment in all relevant clinical areas.

Teaching

Research

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Consistent safe levels of nursing staff across the board in order to care for our patients appropriately

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Two things:
Dedicated frailty unit - fully staffed with OT, Physio, ANPs, nurses, healthcares, and a Geriatrician on site....PANACEA!

Also, we need closer links with our community colleagues & GPs in relation to Frailty, it is essential that the patient remains the focus throughout their 'frailty journey' be that in RCH or a community setting. Joined up/integrated working needed.
Angela

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Frailty                 Identify frail multiple admission patients at the front door in ED and then case manage and track these patients through the hospital to try and speed up discharge and use community links to prevent readmission

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Frailty                 Identify frail multiple admission patients at the front door in ED and then case manage and track these patients through the hospital to try and speed up discharge and use community links to prevent readmission

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Rosie

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Frailty unit/ pathway which will have a dedicated MDT and a bed base that can be managed by  the  frailty team.
Prior to set up nursing team to have an education pathway specific for frailty .
Geriatricians at the front door .

Wendy and Emma

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Sectorised community geriatricians to pull patients out of DGH and into community hospitals, input care into residential and nursing homes, work as part of GP and Community Matron teams.

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Sufficient OT/Physio input to acheive our rehabilitation goals.
A functioning social care setting so that patients can be discharged in a timely fashion

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A visit this week to Musgrove Park to look at the Older Peoples Assessment and Liaison (OPAL) area in their AMU was inspiring.  13 protected beds in their 52 bedded AMU template for frail patients reduced frail patients LOS by 4 days and AMU overall LOS by 0.5 days.
-Frazer

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"Achieving a 4 hour turnaround to protect frail elderly people, who do not have an acute condition that needs hospital care, from being drawn into the acute setting;"
-Frazer

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Acute PD nurse and pharmacist service, maybe even an acute PD team!
Multidiciplinary access for all PD patients as outpatients.
Sufficient outpatient slots so that patients are seen according to NICE guidelines (consultant and PD nurse slots)
?Possibly a Duodopa service

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Frailty Unit
Front Door Eldercare

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Equality of care for all frail patients with major fractures.
Pathway care for fragility fractures.
Frailty Unit and pathway
Front door eldercare to include stroke BPT, TIAs, orthogeris, general frailty.

Adequate staffing to provide good quality training for juniors, nurses and allied health workers.

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Review of number of acute stroke beds needed - with consideration of increasing hyper-acute beds to include management of hypertensive stroke patients. Review of staffing and RN: HCA ratio's in line with stroke RCP guidelines across 7 days, taking into consideration potential plans for TIA clinics and impact on staffing requirements.

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The pathway should identify the frailest entering our services, with early comprehensive assessment and intervention. It should reduce harm from decompensation by promoting the cohorting of the frailest in dedicated areas/services for frail older people. It should connect to new capacity in community services to support the timely discharge of frail older people from acute services. It should communicate the on-going priorities of care for individuals to primary and community care services.
- Frazer

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Stroke and TIA service
Acute stroke unit combined with rapid assessment of minor stroke and TIA 7 days a week. Geriatricians run the acute stroke unit with 3 sessions a day- 2 geriatricians in the morning doing Ward round and 1 in afternoon continuing with TIA clinic and mopping up any new comers at the end of the day. 2nd geriatrician starts at 11am and finishes at 7 pm allowing better cover of evening hours for new admissions. Will need support from junior doc/ stroke nurse to execute tasks after 5pm.
Weekend after TIA clinic on Ward in afternoon review of all new admissions to stroke unit.
Consider pulling stroke rehab into acute hospital from Bodmin and CRCH if we are pulling out of delivery of services there.

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Treat this page as a Wish List for what you think Eldercare should provide and how at Treliske. Can be minor detail or grandiose ideas.
Click on the pink + in the right bottom corner and post your thoughts. Looking forward to presenting this! We can then prioritise after.