The Bermuda Triangle Older People in Emergency Care Dr Veronica Devlin Programme Lead Service Improvement & Clinical Governance Emergency Care NHS Lanarkshire

Reminder of age profile of ED attendances

PERCENTAGE OF ED ATTENDANCES ADMITTED WITHIN AGE GROUP ISD DATA July 2011 to June 2012

How old are people who wait?

Number of Admission by Age Group

Vicious cycle of boarding boarding Wrong bed, wrong skillset Inefficient use of resources Longer ward rounds Late Decision making Late in day discharge Late bed availability Late Bed moves Backflow into ED Push to admit to any bed Vicious Cycle of boarding

Objectives of the ED assessment 2000 Diagnosis and treatment of primary pathology Recognition and understanding of concomitant pathology Social history Communicate with GP Discharge with support – physio, OT, repeat housecall Admit if no alternative Navigate the Bermuda Triangle

Diagnosis and treatment of primary pathology Recognition and understanding of concomitant pathology Screening for occult issues Recognition and respect for social and personal aspects of care Identifying and alerting the network Communicating vital fresh information Avoiding the Bermuda Triangle Objectives of the ED assessment 2012

Challenges of assessment in ED Seeing the person not the pathology Communication Collateral history Comfort Room to move Baggage Marshalling the team Looking beyond the obvious Being aware of and activating the network