“One in three patients over 65 admitted to hospital as an emergency experiences delirium, and many of those have pre-existing dementia. It can be extremely distressing for both the patient and their family. It is vital that we improve delirium care, making our hospitals more delirium and dementia friendly… and the opportunity for GIRFT to make improvements is huge.”

Dr Adrian Hopper, GIRFT clinical lead for geriatric medicine

As Dementia Action Week gets under way across the UK, the Getting It Right First Time (GIRFT) programme is embarking on a series of more than 130 hospital visits in its national review of geriatric medicine.

Led by Dr Adrian Hopper – a physician from Guy’s and St Thomas’s NHS Foundation Trust – the review aims to identify and reduce unwarranted variation to improve the care of frail patients in England, which includes those with dementia and delirium (acute confusion). Deep dive visits have now begun, with the GIRFT team travelling to meet multidisciplinary clinical staff and senior managers at each provider to review trust data, discuss local challenges and identify best practice.

Dementia Action Week runs from 20-26 May 2019, and aims to bring about changes for people with dementia through raising awareness. Figures from the Alzheimer’s Society show there are around 850,000 people in the UK with dementia today. One in 14 people over 65 will develop it, and the condition affects one in six people over 80. By 2025, it is estimated that the number of people with dementia in the UK will have risen to one million.

Dr Hopper said: “We have an ageing population, so business as usual in geriatric medicine just won’t work. If we carry on doing what we are doing, there will be so many frail patients that the NHS will simply collapse.

“Frailty can cause confusion and falls, and one of the most fundamental factors affecting frailty is dementia. Dementia creates problems with how well you can look after yourself, affects how well you recover if you are in hospital and how easy it is to resettle back at home.

“We need swift thinking and effectiveness in our response to frailty across all hospital care, not just in geriatric medicine but also in other medical and surgical specialties. GIRFT is a chance to increase awareness, improve knowledge and bring about new practices to make things better for patients.”

It is expected that visits to trusts as part of GIRFT’s geriatric medicine review will be finished by mid-2020. A national report will also be published. Among the areas of focus for Dr Hopper are:

• Improving the delirium pathway – “Some hospitals don’t have any delirium pathway at all, and there is variation among those that do,” he said. “A big focus of our GIRFT review will be on improving delirium care – we have the opportunity here to make some big improvements.”

• Quality of discharge – working with trusts and other stakeholders (voluntary sector, care homes and community hospitals) to improve support for patients when they go home, and looking for best practice within a supported discharge model.

• Specialist A&E teams for frailty – supporting a national plan for acute frailty assessment in A&E to ensure patients are recognised and treated as frail within 30 minutes of arrival, and working to ensure its effectiveness.

• Targeting length of stay – “We should be aiming to check frail patients out, patch them up and get them home again, all within a day wherever possible as long stays in hospitals can be very disabling for frail patients,” said Dr Hopper. “There is significant variation on this, with between 20% and 50% of patients treated and discharged on the same day, depending on the hospital. There is more we can do to improve these figures.”

Dr Hopper added: “The NHS is one of the most naturally integrated health systems in the world and in GIRFT we are already aware of fantastic innovations to improve quality and effectiveness in geriatric medicine. By learning from the best we hope to improve dementia and frailty care everywhere.” 

The GIRFT geriatric medicine review is supported by the British Geriatrics Society. President Professor Tahir Masud said: “This national GIRFT focus on geriatric medicine is very welcome and timely given the demographic changes in society, and the increasing prevalence of older people with dementia and frailty being admitted to hospitals.

“More consistent and efficient delirium pathways and front door frailty pathways in the emergency departments will help to improve care for older people across the country. They will also contribute to avoiding unnecessary hospital admissions, which in turn should help to alleviate pressure on NHS acute services.”