Editor – I read with interest Taylor et al’s article in the February edition of Clinical Medicine, Embedding comprehensive geriatric assessment in the emergency assessment unit: the impact of the COPE zone (Clin Med 2016;16:19–24).
Their conclusion states ‘services can be improved without major investment.’ May I say that absolutely no assessment on the impact of community services, additional work for GPs, carer stresses, district nurse time or impact on social services was attempted? While Dr Taylor’s trust did not have any major investment to deliver the new unit, what was the cost to the community services?
One geriatrician cannot run a service 365 days a year so there would be cost implications in this alone for their trust. Additionally, comprehensive geriatric assessment requires knowledgeable experienced staff in elderly care. To deliver such a team often means pulling them away from something else equally valuable within the trust.
We need to be careful not to throw the baby out with the bath water running to deliver a frailty friendly front door without robust research evidence. In my elderly care service we are trying to run six wards with six consultants – on three sites, 7 days a week, including orthogeriatrics and surgical referrals, as well internal holiday cover. We already have the highest number of inpatients patients per consultant.
More investment in elderly community services and hospital elderly care is required as well as innovative ways of working. Established hospital elderly care departments should not be put at risk to deliver fashionable trends based on blunt figures such as numbers discharged from the acute medical unit and hospital length of stay. These parameters are not surrogate markers for quality elderly care traditionally delivered within the hospital.