1 / 22

Changing practice to reduce admissions for people with dementia

Changing practice to reduce admissions for people with dementia. Dr Afifa Qazi Consultant Old Age Psychiatrist Havering older people’s services afifa.qazi@nelft.nhs.uk. Evolution of older people’s services. Institution to Care in the community Geriatric services 1940s

tamera
Download Presentation

Changing practice to reduce admissions for people with dementia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Changing practice to reduce admissions for people with dementia Dr Afifa QaziConsultant Old Age Psychiatrist Havering older people’s services afifa.qazi@nelft.nhs.uk

  2. Evolution of older people’s services • Institution to Care in the community • Geriatric services 1940s • Psycho-geriatric services 1960s • Day hospitals • Community mental health teams • Changing role of the consultant

  3. National Dementia Strategy Improved community support services Living well with dementia in care homes • New Ways of Working DOH 2005 improving relations with primary care and community • NICE Guidance for Dementia - support people with dementia in the community as far as possible

  4. Components of the service • Community Mental Health Team • Memory clinic / out-patient clinic • Home Treatment Team • Liaison service • Day hospital • In-patient ward

  5. Diagnosis Follow-up Crisis management Acute Chronic Preventative Dementia care

  6. Population • Havering , borough with most older people Office of National Statistics 2008 • 40,700 over 65yrs • 3400 with dementia • 30% (1100) of those in care homes • Three psychiatric teams covering roughly the same catchment-areas • Very low admission rates

  7. Inpatient admissions Havering(04/09 to 03/10)

  8. Admissions for Team A(04/09 to 03/10)

  9. Average length of stay

  10. Bed usageApril 09 – March 10

  11. Inpatient Admissions NELFTper 10,000 population

  12. Average length of stay - NELFT

  13. Bed Daysper 10,000 population

  14. Bed Occupancyper 10,000 population

  15. Source of referrals • G.P s • Elderly medicine and neurology • District nurses • Care homes

  16. General practice • Close working links with GPs/practice nurses, consultant mobile number • Excellent secretarial support • Quick response (same day) • Talks at surgeries leading to improved quality of referrals, improving GP confidence in managing psychiatric disorders • GPs not good at detecting and managing dementia ( “Forget me not” 2002 audit commission) • Face to face discussions (eg referral for acute confusion)

  17. Care homes (1/3rd of people with dementia) • Close working links with homes & consultant mobile number • Prompt response • Training sessions, talks • Regular “surgeries” at homes with “problems” • Able to identify difficulties before reaching crisis point • No admissions from care homes over last 2 yrs

  18. CMHTsingle point of access • Weekly meetings, discussions • Joint visits • Close links • Home visits 5 days a week • Prompt response and consultant mobile number encouraged to call

  19. Out patient clinics • Emergency slots for patients in a crisis situation • Frequent follow ups for acutely unwell patients (2-4 weekly) • Encourage patients to ring in case of problems (provide contact sheet to all ops with secretaries number)

  20. Patients not falling within day hospital or HTT • Case 1 Mrs EE • Case 2 Mrs ES

  21. Key elements • Access - support • Training – development • Liaising- providing the missing link TEAM EFFORT

  22. Conclusion • Bed occupancy - <10% of RCPsych recommended bed numbers • 1/4 of beds of average NELFT consultants per 10,000 population • Changing practice: • reduces admissions • cost effective • popular with CMHT, care homes and GPs • adds to effects of home treatment services • takes time for full effects

More Related