The Bermuda Triangle

Older People in Emergency Care

Dr Veronica DevlinProgramme Lead Service Improvement & Clinical

GovernanceEmergency CareNHS Lanarkshire

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

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

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

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

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

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