This report from the District General Hospital for Dumfries and Galloway addresses how best to care for patients admitted to hospital with an acute physical illness who also suffer from a dementia. This document highlights some of the current difficulties for dementia sufferers within current service provision, provides background statistical information on national trends associated with dementia incidence, and identifies and evaluate a range of possible options to address the underlying challenges.
The DGRI Dementia Model of Care Group considered several models of service delivery to support this group of patients.
Model A: The current [estimated 2007] model which provides the support of a dedicated Liaison Mental Health nurse for DGRI and is enhanced by the development of Dementia Champions.
Model B: A liaison mental health team which has a clinical lead and dedicated time in the Consultant Psychiatrist’s work plan.
Model C: The development of a shared care ward where mental health and general nurses, psychiatrists, physicians and therapy staff work together to deliver care. This model was discounted, since this unit would be very small and access to the ward controlled tightly. Patients managed within a shared care environment may potentially be disadvantaged from the viewpoint of access to specialist medical services.
Model D: The development of key dementia friendly ward or wards where those patients with a co-morbidity of dementia would access directly from Accident and Emergency. This model was discounted following activity modeling and due to the same concerns about specialty access as Model C.
Model E: This model combines Model A with enhanced training for all staff in the understanding and management of patients with dementia. Patients arriving within this model would transfer to the appropriate ward for their physical condition and receive care from more knowledgeable staff throughout NHS D&G.
Model E was judged to be the preferred model. In this model a bank of healthcare assistants would enable rapid access to one to one support for patients. This model assumes that all patients who can be managed without the intervention of a specialist unit, and for whom dementia is suspected, are transferred directly to a dementia friendly ward.
The ideal pathway for dementia patients takes these patients directly to a ward that is dementia friendly and transfers to a specialist ward from A&E when the patient is in need of specialist input.
Wood, E. Rhind, G [and] Holden, R. [et al]. Acute Services for patients with co-morbidity of dementia. Dumfries and Galloway: Dumfries and Galloway Royal Infirmary (DGRI) Dementia Model of Care Group, [undated report, estimated 2007].