“Being frail and staying in hospital for a long period of time is not good for your health”
With UK life expectancy currently 79.2 years for men and 82.9 years for women, treatment of the frail and elderly is one of the NHS’s top priorities. Dr Matthew Sweeting, consultant geriatrician and clinical lead of the department for medicine for the elderly, is leading a transformation in frailty care at Broomfield which is hoped will benefit the health of elderly patients by shortening their stays in hospital.
Dr Sweeting explains: “Frail elderly people are more vulnerable than the general population. Whereas you or I might get a chest or urine infection, take antibiotics and get better after a few days, an older person may have an infection, take to their bed and become deconditioned. What starts as a relatively minor illness can lead to a whole series of problems resulting in major loss of function and sometimes even death.”
“For many older folk, hospital is confusing and noisy, especially if they suffer from dementia. As they are not familiar with the environment, their risk of falls can increase and they can become more confused and stop eating and drinking.
“Being frail and staying in hospital for a long period of time is not good for your health – that’s the key message.”
The frailty unit at Broomfield Hospital opened in September 2016 with the aim of ensuring frail patients are seen quickly by the most appropriate team.
It’s a seven-day, multidisciplinary service that includes a consultant geriatrician, junior medical staff, frailty nurses, therapists, a social worker and dedicated dementia support.
“The big aim is that frail old people are seen quickly and undergo a comprehensive multidisciplinary assessment early on in their admission. The team will assess, treat, diagnose and discharge plan in rapid succession. It’s intense but our stats are very exciting.
“Our patients have an average length of stay of just three days - half that of over-80s who are admitted through general medicine - and our readmission rates are the same. So we are performing well in that respect.”
Dr Sweeting, who is also clinical lead for STP acute frailty with responsibility for aligning the services across Mid Essex, Southend and Basildon, wants to change perceptions around frailty.
“We must continue to teach all healthcare professionals that frailty is everyone’s business, not just the frailty team. We are developing core ‘frailty competencies’ across the organisation to equip healthcare workers to manage our ever-increasing frailty cohort.
“It’s also important to convince the patients and their relatives that staying in hospital unnecessarily is not the safest option. We know that most frail patients perform far better in their own home."
Between 40% and 50% of Broomfield’s medical take is classed as medically frail, so an additional care of the elderly ward - Bardfield – has been added to reflect this. This is the first step in a series of moves that Dr Sweeting says will see the hospital become “a more frailty-friendly environment”.
“The plan is for the frailty unit to move from ESS to its new home on Felsted with an ambulatory unit attached to the ward. Very soon, we will be able to offer direct access to the frailty team from the community and our very busy Emergency Department. We believe that ‘seeing the right patient at the right time, in the right place’ is key. That’s what we want to improve on.”
But, Dr Sweeting says, none of this would be possible without the help his team have received.
“I’ve been humbled by kind colleagues who’ve supported the work. The executive team have funded a lot of our services and the CCG have also supported us. I’m grateful we’ve been allowed to carry the vision forward and look forward to what 2019 holds.”