Response
Editor – We thank the correspondent for their letter regarding our recent article Embedding comprehensive geriatric assessment in the emergency assessment unit: the impact of the COPE zone.1 Care of frail older people admitted non-electively to hospital remains variable across the country, as highlighted in the recently published Older people in the acute setting NHS benchmarking report (available at www.nhsbenchmarking.nhs.uk/projects/network-projects.php#14). The COPE zone was developed from an established geriatrician in-reaching model. The job plans of pre-existing geriatricians and therapy staff were simply reconfigured, therefore the unit worked from the advantage of already having the team in post. Our data did not show any difference in observed outcomes for older people not admitted to the COPE zone, and the authors do not feel this service change led to any reduction in quality of service elsewhere. It is fair to say that there is a nationwide issue with financial constraints, workforce limitations and overworked staff as highlighted by the Royal College of Physicians special report Hospitals on the edge? The time for action, published in 2012. The correspondent is correct to highlight the potential implications on community services by promoting rapid discharge form hospital, an issue which has not yet been audited at Salford Royal Foundation Trust. We also agree with the correspondent’s concern that length of stay and discharge rates should not be the primary objective of any hospital service. The main aim of the COPE zone is to improve the quality of care for older people admitted to hospital by providing timely multidisciplinary comprehensive geriatric assessment, an outcome which has been better achieved by this service redevelopment strategy. The British Geriatric Society states that ‘geriatricians have a responsibility to engage in the acute medical care of older people through participation, development of innovative services, and education’.2 Bringing geriatrician input earlier into the patient journey is a core priority backed by national guidance.2,3
- © 2016 Royal College of Physicians
References
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- Taylor JK,
- Gaillemin OS,
- Pearl AJ,
- Murphy S,
- Fox J
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- Conroy S,
- Cooper N
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- Future Hospital Commission
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