This is the third in a series of acute care toolkits. It recommends procedures for the initial assessment on admission, and later Comprehensive Geriatric Assessments (CGAs), as ways to improve the care of frail older patients. The toolkit has been produced by the Royal College of Physicians in collaboration with the British Geriatrics Society.
“The toolkit has a handy 30 second guide to frailty syndromes that will help doctors distinguish between a variety of possible conditions underlying the frailty (such as falls, delirium and dementia, and incontinence), leading to better diagnosis, fewer unnecessary admissions, and a reduced need for long-term care. In addition to communicating effectively with the patient, doctors should talk to carers or relatives if possible to get a full picture of the older person’s illnesses and how they are being treated, which can save unnecessary investigations and treatment”.
Acute medical units (AMUs) encounter increasing number of frail older people requiring acute care, so AMU staff should be aware of this toolkit covering the knowledge and skills for managing frail older people. This document discusses the challenge of non-specific presentations, such as delirium, which may mask underlying pathology. The delivery of holistic assessments in AMUs is a lot to ask from busy acute teams; but geriatric liaison teams – with the skills and time to focus on frail older people – can be called for assistance.
The RCP toolkit calls for better integration between primary care, emergency departments, AMUs and geriatric services, with a view to working together to achieve higher standards of urgent care, while reducing duplication of effort and costs, and improving patient outcomes.
Toolkit for improving care for frail older people. London: Royal College of Physicians, March 2012. 6p.
Earlier RCP Toolkits
Acute Care Toolkit 1: Handover
Handover is the transfer of responsibility for immediate and ongoing care between healthcare professionals. This toolkit focuses on good handover, looking at problems sometimes experienced, and giving recommendations for improved, standardised handover. Two templates provide a handover proceedings sheet and a form for out-of-hours handover. There is an earlier RCP council report (May 20th 2010), “A scoping project: Handover – the need and the best practice”.
Acute care toolkit 1: Handover. London: Royal College of Physicians, May 2011. 4p.
Acute Care Toolkit 2: High-Quality Acute Care
This toolkit looks into the delivery of high-quality acute care, examining problem areas and factors threatening care delivery. Recommendations are offered for improving quality. Two appendices give the RCP position statements on out-of-hours care, and guidance notes on the provision of 12-hours-per-day, 7-days-per-week consultant care.
Acute care toolkit 2: high quality acute care. London: Royal College of Physicians, 2011. 6p.