15 Presenting evidence for service improvement;the care of older people living with frailty in acute hospital settings

Objectives The challenge of implementing good evidence into practice has long been acknowledged. In 1968, Lord Rosenheim (then President of the Royal College of Physicians) told the World Health Organisation that if no further research were undertaken for the next twenty year but instead there were to be wholesale implementation of existing evidence, world health would be transformed (Bradley et al. 2010). The objectives of this project were two fold; to present an integrated narrative of the current state of evidence to explore how this could be used to inform a quality improvement collaborative. Method A non-systematic search of NIHR funded research (including Cochrane reviews) identified 53 studies which were thematically analysed. The review (Comprehensive Care) was structured around the chronological journey through acute services with a cross cutting section on the therapeutic benefits of caring environments. The evidence was contextualised with commentary and findings from other researchers, painting a picture of the uptake of the evidence in NHS practice. The review contain a number of reflective questions for provider boards, practitioners and older people living with frailty and their families. Recognising that decisions about practice are based on a trilogy of evidence, values and resources Wessex Academic Health Science Network used the review with providers within to create a local improvement collaborative. All acute Trusts in Wessex were invited to complete an audit based on the review questions. Results There is strong evidence that the use of frailty indices and Comprehensive Geriatric Assessment (CGA) to identify older people living with frailty can reduce harms, mortality and admission to residential care; however, there is poor transfer of information between social care, primary care and secondary care only 42% of acute Trust undertake early CGA. Older people living with frailty access all parts of hospital care but awareness of the frailty syndromes is low in staff outside specialist older people’s services. This presentation will describe how the AHSN developed an audit based on the themed review and how the audit findings will be used a group of acute care staff to improve care planning and delivery. Conclusions Robust research with clear findings is the start of a journey to provide excellence in health and social care. Combining different research evidence into a narrative around a holistic patient experience can illuminate the challenges in developing service designs that meet the needs of older people living with frailty within complex acute services. A QI project to create a consensus and audit of best practice is a further step towards implementing the evidence. References Bradley E, Mcsherry W, Mcsherry R. Disseminating research: how joint NHS and university posts can support this process. Nursing Times 2010;106(44):20–22. NIHR Dissemination Centre. Comprehensive Care 2017. http://www.dc.nihr.ac.uk/themed-reviews/comprehensive-care.htm