LAUSR

Introduction: Older people represent nearly two-third of admissions to hospitals in the UK, and many are at high risk of poor healthcare outcomes including long length of stay and admission to care homes. Early identification of these patients would allow appropriate interventions to improve outcomes. It is unclear whether and how they are identified within current practice. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes. Methods: A random sample of 60 patients’ clinical records from five geriatric wards in one hospital were reviewed for evidence of risk assessments occurring routinely on admission. In addition, semi-structured interviews/focus groups were conducted with 22 healthcare staff across the study wards including: 7 nursing staff, 4 dieticians, 7 medical staff, and 4 therapists. Results: A number of risk-assessments take place routinely early on admission including, assessment of nutrition using Malnutrition Universal Screening Test (MUST) score (85% patients), recognition of dementia and delirium using (77%), risk of falls (95%), moving and handling assessment (85%), and pressure ulcers assessment (88%). However, there was no explicit tool to identify older patients at risk of poor healthcare outcomes. Qualitative data revealed that healthcare staff depend on “clinical judgement” to recognise high-risk patients based on detailed collateral history about patient’s general condition, reasons for admission, ability to manage at home and level of care needed, number of comorbidities, and patient’s engagement with therapy assist professional judgment. Yet, most often making such a judgment occurs several days after admission potentially delaying interventions. Conclusions: Although a number of risk assessments are used routinely on admission to geriatric wards, explicit identification of patients at risk of poor healthcare outcomes is missing. Staff rely on clinical judgement which often occurs later on admission potentially delaying interventions.