Background It has been highlighted in the BGS' “Quest for Quality” that care home residents are becoming older, frailer, and more complex. These demographic changes have made the social care model increasingly unsuitable. Compounded by withdrawal of the NHS from the care home provider sector, we have seen an increase in emergency admissions from care homes. Prior to our new service the Whittington Hospital received an average 32.5 emergency admissions per month from just 437 nursing home beds, accounting for 502 bed days per month.
Innovation In response to a fragmented model of medical care in care homes, often punctuated by acute admissions, we developed the ICAT service. A community geriatric service led by three consultant geriatricians and a GPwSI. The service aims to provide quality, integrated care in care homes, improve communication between secondary and primary care, and reduce unnecessary hospital admissions. It does so through joint geriatrician/GP care home visits; specialist review of all residents admitted to hospital; a direct access telephone advice line; regular teleconference multidisciplinary meetings; and multidisciplinary educational workshops.
Evaluation The service has been running for one year and now sees ∼40 residents per month in care homes, and conducts 4 teleconference MDM's per month. Since its introduction admissions to the Whittington hospital have fallen from 32.5 to 24.2 per month, with a resultant 18% reduction in bed days despite an 8% rise in length of stay.
Conclusion The service has succeeded in delivering iterative holistic assessment of care home residents across the care continuum, improved communication and integrated working, and helped support learning and development in care homes. In doing so, it has added to the growing body of evidence that community geriatric services that deliver better integrated patient centred medical care in care homes can reduce burdensome avoidable admissions.