Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)

Inderpal Singh,1 Priya Fernando,1 Jane Griffin,2 Chris Edwards,2 Kathryn Williamson,3 Patrick Chance2 1Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, 2Royal Gwent Hospital, Aneurin Bevan University Board, 3Department of Old Age Psychiatry, Ysbyty Ystrad...

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Autores principales:	Singh I, Fernando P, Griffin J, Edwards C, Williamson K, Chance P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Older people frailty index mental health mortality critical illness hospitals. Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/446da5b4812247bdbec015b9891ba95c
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spelling	oai:doaj.org-article:446da5b4812247bdbec015b9891ba95c2021-12-02T01:06:40ZClinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)1178-1998https://doaj.org/article/446da5b4812247bdbec015b9891ba95c2016-12-01T00:00:00Zhttps://www.dovepress.com/clinical-outcome-and-predictors-of-adverse-events-of-an-enhanced-older-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Inderpal Singh,1 Priya Fernando,1 Jane Griffin,2 Chris Edwards,2 Kathryn Williamson,3 Patrick Chance2 1Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, 2Royal Gwent Hospital, Aneurin Bevan University Board, 3Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales, UK Background: Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods: Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results: The new Rapid Assessment Interface and Discharge service assessed 339 patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04 years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 (P<0.001, paired t-test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20 days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2 days), leading to a total annualized bed savings of 44 days. FI was the most highly significant factor between patient groups with a good and poor outcome (P=0.00003, independent groups t-test, t=-4.38, df 98). Conclusion: Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes. Keywords: older people, frailty index, mental health, mortality, critical illness, hospitalsSingh IFernando PGriffin JEdwards CWilliamson KChance PDove Medical PressarticleOlder peoplefrailty indexmental healthmortalitycritical illnesshospitals.GeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 12, Pp 29-36 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Older people frailty index mental health mortality critical illness hospitals. Geriatrics RC952-954.6
spellingShingle	Older people frailty index mental health mortality critical illness hospitals. Geriatrics RC952-954.6 Singh I Fernando P Griffin J Edwards C Williamson K Chance P Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
description	Inderpal Singh,1 Priya Fernando,1 Jane Griffin,2 Chris Edwards,2 Kathryn Williamson,3 Patrick Chance2 1Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, 2Royal Gwent Hospital, Aneurin Bevan University Board, 3Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales, UK Background: Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods: Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results: The new Rapid Assessment Interface and Discharge service assessed 339 patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04 years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 (P<0.001, paired t-test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20 days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2 days), leading to a total annualized bed savings of 44 days. FI was the most highly significant factor between patient groups with a good and poor outcome (P=0.00003, independent groups t-test, t=-4.38, df 98). Conclusion: Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes. Keywords: older people, frailty index, mental health, mortality, critical illness, hospitals
format	article
author	Singh I Fernando P Griffin J Edwards C Williamson K Chance P
author_facet	Singh I Fernando P Griffin J Edwards C Williamson K Chance P
author_sort	Singh I
title	Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
title_short	Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
title_full	Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
title_fullStr	Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
title_full_unstemmed	Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)
title_sort	clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: rapid assessment interface and discharge (newport)
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/446da5b4812247bdbec015b9891ba95c
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Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)

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