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Background A hospital's trolley count is often highlighted as a measure of its performance. However there is a more complex reality for each organisation in accessing suitable resources for often frail older patients to improve care and capacity. Coupled with this is the need for pathways that identify these patients early in their admission and access the appropriate specialist care.  In 2018, 65% of this hospital's bed days were occupied by those whose hospital stay was greater than 14 days. Nationally this was 57%. We undertook to review processes locally around the care of older acute patients. Methods On the 20th November 2018 we conducted a chart audit of 85 in-patients who had been in the acute setting for more than 14 days. A proforma was completed for each patient by a doctor and multi-disciplinary team member. Results The length of stay ranged from 15 – 527 days with the median being 41 days. The average age was 76 years. A history of falls/dementia/"acopia" was recorded on admission in 57%. The mean time for referral to MDT was 5 days. Social history was only documented in 47% of cases. Ward transfers was a significant issue with 69% moving wards at least once and 9% moving three times or more. A care planning meeting had not been held in 49% of cases. Over 17% of charts audited were awaiting home care package hours whilst 20% were awaiting long term care. In 62% of cases there was no ongoing medical reason keeping them in hospital and 56% of this cohort could have been cared for elsewhere. Conclusion Deficits in clear communication and appropriate timely planning for patients resulted in significant delays in discharge. The findings of our research informed a decision to conduct a root and branch analysis of discharge planning utilising the Lean Six Sigma model. [ABSTRACT FROM AUTHOR]

Background The Clinical Frailty Scale (CFS) is widely used to assess frailty in older adults and reflects functional independence. We examined its use as an outcome measure in an offsite rehabilitation unit for patients over 65 transferred from an acute hospital following medical/surgical admission. Methods Patients were given a CFS score by consensus opinion from the multidisciplinary team on admission and on completion of rehabilitation. We included data on diagnosis, length of stay and discharge destination Results Thirty patients, with a mean age of 80, completed rehabilitation over a four-month period. The most common diagnosis was fracture of hip or pelvis (53%). Median CFS was 6 on admission and 5 on discharge (range 3-8). Twenty-one (70%) patients saw an improvement in CFS of an average of one point on the scale irrespective of admission score. Of those that improved, 81% were discharged directly home with no need for increased support services, compared with 11% of those who did not improve. Mean length of stay was significantly less in those with mild/moderate frailty (CFS 5-6) at admission versus severe frailty (31 vs 53.8 days, p<0.01). Conclusion Frailty score improved in the majority of patients undergoing rehabilitation, regardless of admission score; CFS alone did not predict rehabilitation potential, emphasising the importance of offering rehabilitation to frail older adults – better judged by experienced clinical assessment. CFS is a broad 9-point tool that can miss small improvements in physical function based on other objective scores e.g. FIM+FAM. Severe frailty was associated with longer length of stay in rehabilitation, possibly reflecting more complex discharge planning as well as rehabilitation progress in this group. [ABSTRACT FROM AUTHOR]