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The Bermuda Triangle
Older People in Emergency Care
Dr Veronica DevlinProgramme Lead Service Improvement & Clinical
GovernanceEmergency CareNHS Lanarkshire
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Age Profile of ED Attendances
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
00-25 26-45 46-64 65-84 85+
Age
Reminder of age profile of ED attendances
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PERCENTAGE OF ED ATTENDANCES ADMITTED WITHIN AGE GROUP
0
10
20
30
40
50
60
70
0-4 5-9 10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85+
Proportion admitted (%)MALEProportion admitted (%)FEMALE
•ISD DATA July 2011 to June 2012
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How old are people who wait?NHS Scotland: ED Activity
4-hr breaches by age band (% of total)
0
2
4
6
8
10
12
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
4-hr
bre
ache
s (%
of t
otal
)
Nov-11 Dec-11 Jan-12
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NHS Scotland - Multiple emergency admissions by number of admissions and age group: 2010/2011
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Age 00 - 09 Age 10 - 19 Age 20 - 29 Age 30 - 39 Age 40 - 49 Age 50 - 59 Age 60 - 69 Age 70 - 79 Age 80+
Num
ber o
f pat
ient
s
1 admission 2 admissions 3+ admissions
Source: ISD Scotland - NHS Multiple Emergency Admissions management information. Results are intended for management information only and are
Number of Admission by Age Group
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Vicious cycle of boarding
boarding
Wrong bed,
wrong skillset
Inefficient use
of resources
Longer ward
rounds
Late Decisionmaking
Late in day
discharge
Late bed availability
Backflow into ED
Late Bed
moves
Push to admit to any bed
ViciousCycle
of boarding
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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
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• 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
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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
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