Early comprehensive geriatric assessments (CGA) conducted within 24 hours of admission led to shorter hospital stays and better care planning for elderly patients admitted to Wigan Infirmary compared to general geriatric admissions. A single geriatric trainee and nurse practitioner performed CGAs on 20 patients over 8 weeks using a pre-piloted assessment document, identifying needs for further testing, social services, medication reviews, and rehabilitation. The CGAs also facilitated advanced care planning addressing post-discharge needs. Patients who received early CGA had a mean length of stay of 5.9 days versus 12.2 days for general geriatric admissions, demonstrating the effectiveness of early CGA with limited resources in a district general hospital setting.

1. Impact of early ComprehensiveGeriatric Assessment inPatients
admittedto Wigan Infirmary
E Pickavance, MHart, A Kumar
Departmentof ElderlyCare,Royal AlbertEdwardInfirmary (RAEI)
Background
Previous research has demonstrated the benefit of an early (within 24 hours) Comprehensive
GeriatricAssessment(CGA) amongstelderlypatientspresentingto hospital (Caplan et al, J Am. Geri
Soc, 2004, 52(9). CGA should encompass all aspects of the patient’s health in a single process and
allowforadvanced care planning. Thisprocesshasbeen shown elsewhere to reduce length of stay
(LOS) (Nikolaus et al, Age & Ageing, 1999, 28(6).
Innovation
Previous research has been based within large clinical settings with many resources. This project
aimed to assess whether the early CGA process could be effectively delivered within a small DGH
environment with limited resources and Geriatricians. The project was carried out by a single
Geriatric trainee and Nurse Practitioner whilst continuing with their usual clinical commitments,
reflectingthe limitedrecoursesof manyDGH’s. All CGA’swere performedwithintwenty-four hours
of admission to RAEI using a pre-piloted CGA document. The results and recommendations from
the CGA were communicated to the patient’s medical team for on-going care.
Evaluation
20 patients were assessed over an 8 week period. Each CGA led to recommended acute
interventions and advanced care planning. Acute interventions recommended included further
medical investigations, social care planning, medication review, falls assessment and the need for
rehabilitation. Advanced care planning requirements were identified for increased social care,
psychogeriatric services, community matron support, respite care, and referral to specialist heart
failure, palliative care, diabetes, continence and falls teams.

2. Mean LOS amongst the CGA group was to 5.9 days compared with 12.2 days amongst the general
Geriatric admissions to the RAEI.
Conclusion
Despite limited timeandskilledresources the earlyCGA canbe effectivelydelivered within the DGH
settingand reduceslengthof stay. It enablesearlyspeciality Geriatric involvement in care to allow
early and effective advanced care planning.
Submitted to BGS on 28/5/13. Ref AM-50