Background: Comprehensive geriatric assessment including cognitive assessment results in better outcomes and quality of life through facilitating access to support and further care. The National Audit of Dementia Care revealed too few patients were being assessed for cognition and therefore failing to receive adequate care. Methods: This was a retrospective clinical audit in a district general hospital with systematic sampling of the clinical records of 50 inpatients on an elderly care ward. A descriptive analysis of the results was performed. Results: Despite guidance that cognitive assessment should be performed on admission, this was only documented in 22% of the medical notes. However, this rate improved to 56% by discharge. The most commonly used tool was the Abbreviated Mental Test (AMT) 10. Assessment completion was independent of gender or social support, but only patients aged over 75 years were assessed. Of those, 75% had some level of cognitive impairment and 36.8% received a new or suspected diagnosis of dementia. Discussion: Cognitive assessment rates continue to be low. Our findings support the need for increased education regarding the importance and benefits of assessment as well as how to complete and document the assessment correctly. Conclusion: Cognitive assessment rates need to be further improved to promote better outcomes for patients with dementia.
Aims
To introduce a community based nurse-led service with the aim of reducing unscheduled paediatric admissions into hospital, which can safely be managed in the community. Locally, 56% of unscheduled acute admissions into hospital are made by General practitioners (GP). Of these 46% are discharged home within 6 h.
Methods
The service was run as a 12 month pilot project. Staffed by children's nurses with advanced minor illness management skills, the service provided follow-up visits in the home for children with mild to moderate episodes of minor illness. The target group were children who would otherwise have been admitted to hospital by the GP, Emergency Department or Walk-in-centre. A robust referral system ensured the children were safely discharged home for follow-up. A cluster of GP's, paediatric ED specialists and a consultant paediatrician had input in development of the service.
Results
The pilot project received 586 referrals. 195 referrals (33%) identified as admission avoidance. Others were referred by clinicians identifying a need for nursing support after discharge. 22 referrals (4%) were returned to hospital for medical review or admission due to change or deterioration in condition. There were no deaths or serious incidents. User satisfaction was high as reported through a service review and evaluation process.
Cost analysis
Cost to run the service, £160 564. Average cost per referral into the service, £274. ED admission costs £60, hospital admission, £260 on first contact, rising to £700 for a stay >4 h. Total saving £113 340, assuming that the majority of admissions into hospital incur the higher fee. The lesser cost of ED admission is accounted for.
Conclusions
The cost of delivering the service was greater than the savings realised. However, some savings may not have been counted as it is not possible to identify where parents would have sought medical advice had this service not been available. Some over and under estimation of savings may have arisen for differing lengths of hospital stay. Attracting referrals based on admission avoidance would increase service productivity. Families valued the service highly; felt supported, reassured and recognised the significance of avoiding hospital admission.
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