Dementia care in acute hospitals. Royal College of Psychiatrists 1 identified that on average in a 500-bed district hospital: 330 beds will be occupied by older people 220 of these will have a mental health disorder of which 102 will have dementia (depression and delirium form most of the rema
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1. Improving general hospital care for people with dementia: why, how and with whom? Nye Harries
2. Dementia care in acute hospitals Royal College of Psychiatrists 1 identified that on average in a 500-bed district hospital:
330 beds will be occupied by older people
220 of these will have a mental health disorder
of which 102 will have dementia
(depression and delirium form most of the remainder)
1. Who Cares Wins: improving the outcome for older people admitted to a general hospital, Royal College of Psychiatrists, 2005
3. Who care wins on outcomes
Research studies cited in the RCP report highlight a range of important outcome measures for this group:
longer lengths of hospital stay
greater rate of institutionalisation in a care home following their acute stay
4. National Dementia Strategy Objective 8: Improved quality of care in general hospitals
To improve the quality of care and health outcomes for people with dementia
To provide a comprehensive mental health assessment and advice on planning of care.
Develop explicit care pathways
Senior clinician lead
Includes community hospitals too!
NAO estimate excess cost over Ł6 million pounds per year per acute hospital.
One SW review site (2009): data showed that FNOF with dementia diagnosis had 25% longer stay in hospital
Dementia is a know risk factor for delayed transfers
Financial & performance impact
6. Typical problems in the acute setting.
Recognition of dementia.
Majority unknown to mental health services.
Discharge planning, limited options for rehabilitation, intermediate care, step down beds to facilitate discharge home.
Poor risk assessment false assumptions
7. Problems... Poor recognition and care, with higher risks in hospital of :
Malnutrition & dehydration
Inadequate pain relief
Poor end of life care
8. Improving general hospital care : key challenges Seeing dementia/cognitive impairment as a whole Trust issue, not just elderly care
Securing executive sign-up
Making the link with the Trust “performance” agenda – LoS. Demonstrating the value of effective pathways, input of liaison .
Ensuring good data – eg clinical coding
9. Breakdown of RUH Inpatient Bed Days by age cohort, 2008 / 09
10. RUH inpatient bed days by age for Surgery/Ortho/MAU/Gen Med: 2008/09
11. What levers could help you? Extra focus on LoS reduction in 2010/11
Sharing data from the new national audit
C-QUIN, with commissioners
Trust Quality Accounts
Sharing data from the new audit
Patient Related Outcome Measures (PROMs)
12. Who are your potential allies?
Director of Nursing & Chief Executive
Council Overview & Scrutiny Committee