One of the key issues which the NHS faces is whether elderly patients should be admitted to hospital at all due to the high risk of COVID infection as well as the risk of falls and de-conditioning.
The major responsibility of looking after the healthcare needs of older patients and their families is taken on by Primary Care professionals and Care Homes. They face considerable challenges in doing so, in the current pandemic and alongside the current winter pressures. This has accelerated the use of innovative approaches to support elderly patients and other vulnerable patients in need.
One proven approach is the use of Consultant Connect for rapid specialist Elderly Care Advice & Guidance. Our data shows that 63% of calls to Elderly Care Advice & Guidance lines result in an avoided hospital visit. Ultimately, this could even be a lifesaver for some older patients.
Let’s now look at some patient case studies…
- Dr Rikin Patel, GP in the NHS West Essex CCG area, shares a recent example:
Dr Patel saw an elderly patient who visited him after having stents fitted abroad. The patient’s medication had run out. The patient had had two previous myocardial infarctions and reported 4-5 stents being present, but all medical notes provided to Dr Patel were not in English. Due to the procedures being carried out abroad and the ongoing medication advice given to the patient not matching the local NHS equivalents, Dr Patel was uncertain of the next steps.
Dr Patel used the Consultant Connect service to speak to a Cardiologist. Together, they worked out what medication the patient needed to stay safe in primary care while waiting for their outpatient appointment. Click here to read the full case study.
- Dr Cristina Guallar, GP in Southwark and Dr Patrick Davey, Consultant Cardiologist, share how the service enabled them to provide effective cardiology care for an elderly patient:
“The patient benefited from a phone conversation with a consultant in two ways. Firstly, she was able to immediately start blood thinning treatment, which protected her against a stroke. Secondly, Dr Guallar could use my name to access early local cardiology services and assessment for aortic valve surgery, which, if possible, would dramatically improve symptoms and life expectancy. Without this phone conversation, it is likely that the referral would have been through the standard route and could have taken many months, during which time she would have been at risk of stroke and may have died from her narrowed aortic valve.” Click here to read the full case study.
- Steven Evans, a paramedic for the Welsh Ambulance Services NHS Trust (WAST), shares an example of how using the service helped avoid A&E for an elderly patient:
“An elderly patient had recently been discharged following ten days in hospital due to a cerebrovascular accident. Given their history, mobility, gait issues, and the fact they lived at home with their elderly wife, who was also frail, the carer was uncomfortable managing the situation. The situation could not be escalated without an assessment from an Occupational Therapist (OT). I arrived at the patient’s house and used Consultant Connect to contact the stay well@home team rapidly.
Following a lengthy discussion, we received amazing support from an OT who arrived at the patient’s home an hour after contact. They carried out a full assessment at home, and at the same time, we were able to liaise with the Care Services, which resulted in continued care at home for the patient. This was very helpful and a fantastic response from the stay well@home team. This was the best outcome for the patient and their wife as they were able to remain at home instead of being taken to A&E.” Click here to read the full case study.
- Dr Emma Rowley-Conwy, GP in Lambeth, shares an example of how using the service enabled her to deliver integrated care for a vulnerable, elderly patient with swollen lower legs and joint pain:
“I spoke to a Rheumatology Consultant at Guy’s and St Thomas’. He confirmed he was seeing the patient himself the next week. The consultant reviewed the blood results and confirmed a likely diagnosis of Rheumatoid Arthritis and advised they would most likely give Depomedrone injection and then consider DMARD. I was able to relay this information to the patient and his wife, which I believe made them feel less anxious. I saw the patient after he had seen Rheumatology, and this was the care he had received. He was much, much better – a really dramatic improvement. Speaking to the consultant made me feel confident to continue to support the patient and his wife, and meant they knew what was likely to happen. They had a chance to read preparatory patient information so could make an informed decision regarding starting a DMARD in that first outpatient appointment.“ Click here to read the full case study.
- Dr Andrew Russell, A&E consultant at University Hospital Monklands, NHS Lanarkshire, shares his experience:
An elderly female patient in a nursing home had a fall, which resulted in a scalp wound. The wound had been managed by a staff nurse on site with steristrips but the wound needed further treatment. The nurse had phoned NHS 111 and been directed to the Flow Navigation Hub and told to wait for a call via Patient Connect. Dr Andrew Russell, an A&E consultant at University Hospital Monklands then phoned the nurse to discuss via patient Connect. The patient would have required ambulance transfer both to and from hospital, so Dr Russell phoned the out-of-hours hub to get the number for the area district nurse. Click here to read the full case study
- A GP, who wishes to remain anonymous shares her experience:
The GP had a visit from an elderly male patient who had experienced an anaphylactic reaction to the Cholera vaccine when he was young and was told to avoid any vaccines in future. He had not had any vaccinations since then but was quite keen to have the COVID-19 vaccine. However, he was very concerned and anxious, wishing to get advice from the immunologists and have allergy tests, if needed. The GP used the Consultant Connect App to contact a local immunologist from the local hospital and was able to feedback the reply to the patient the same day. The patient felt reassured and was grateful for a quick answer from the expert to his concerns. He was then able to have his COVID-19 vaccine in the same week. Click here to read the full case study.
- Dr Anne Mullin, a GP Glasgow, shares her experience:
An 88-year-old patient was “found to be profoundly hyponatraemic (causing bradycardia and dizziness).” He had “recently undergone tests to investigate retinal artery occlusion.” Urea and Electrolyte results came back late from the lab. Using Consultant Connect’s Telephone Advice & Guidance service, Dr Mullin was able to immediately contact a consultant at Queen Elizabeth University Hospital to discuss the follow up options.
The patient was “seen at the Department for Medicine for the Elderly the following day where appropriate investigations were performed, and his medication was reviewed.” Dr Mullin says that “this avoided a late evening admission as [she] could discuss the patient’s current functional status with the consultant planning the follow up (which was very prompt).” As a result of using Telephone Advice & Guidance, an “unnecessary admission” was avoided. Click here to read the full case study.
- Consultant Geriatrician in Sunderland, Dr Catherine Barnes explains why she likes answering Telephone Advice & Guidance calls:
The Recovery at Home Team were concerned about an elderly patient, living on her own at home. She was known to have Chronic obstructive pulmonary disease but had recently become more breathless. The patient complained of weight loss and a poor appetite and explained she had been collapsing at home. She had recently been seen in the Emergency Department, but they felt she wasn’t improving.
“We arranged an urgent Outpatient Clinic appointment, which she attended. We were able to assess her, with access to her medical records and previous investigations. Blood tests, an ECG and lying and standing Blood Pressure were checked and advice with regards to changes to her medication was given. We were able to liaise with other services involved in her care. This enabled the patient to get the assessment and support she needed without an emergency admission.” Click here to read the full case study.
For more case studies where Enhanced Advice & Guidance benefitted patients, click here.
To discuss how Enhanced Advice & Guidance could help GPs and other clinicians caring for elderly patients in your area, please call us on 01865 261467 or email us at info@consultantconnect.org.uk.
