Continuity of care for older hospital patients

http://www.kingsfund.org.uk/document.rm?id=9489

The scope of this study is limited to what happens inside hospital. It does not look at what
happens before people come into hospital, or follow them to their own homes or into
residential or nursing care, and so it does not have much to say about continuity of care
across sectors or the co-ordination of health and social services in the community. We
know that transitions into and out of hospital are critically important to older people’s
health and well-being, and that for a very long time they have been ‘one of the most
problematic areas of policy and practice’ (Glasby 2003; Ellins et al 2012).
Continuity and the co-ordination of care are fundamental to high-quality, cost-effective
health care. In the context of acute care, the risks of fragmentation and breakdown in care
co-ordination are high, especially for older patients.
The scale of the problem and the number affected is unknown, but it quite clear that a
very great many older and very old patients are receiving sub-optimal care. Too many
patients and carers do not know ‘who is in charge’ of the patient’s care, who they can talk
to about it, and how to get answers to their questions.
Relatively small changes in practice can significantly strengthen patients’ and carers’
relationships with clinicians and contribute to greater consistency of clinical management.
Solving the deep and systemic problems that underlie many of the problems, however,
requires the commitment of the senior leadership of the hospital, a deliberate strategic
intent, clear aims, investment in and knowledge of service improvement methods, a
willingness and persistence to pursue the goals over months and, if necessary, years, and
the capability to measure and monitor the changes.