• Kate M Silvester, Mohammed A Mohammed, Paul Harriman, Anna Girolami, and Tom W Downes.
• Health Sciences Research Institute, Warwick Medical School, Warwick, Warwickshire, UK University of Warwick, Warwick, Warwickshire, UK.
• Age Ageing. 2014 Jul 1; 43 (4): 472-7.

Backgroundhospitals are under pressure to reduce waiting times and costs. One strategy that may be effective focuses on optimising the flow of emergency patients.Objectivewe undertook a patient flow analysis of older emergency patients to identify and address delays in ensuring timely care, without additional resources.Designprospective systems redesign study over 2 years.Settingthe Geriatric Medicine Directorate in an acute hospital (Sheffield Teaching Hospitals NHS Foundation Trust) with 1920 beds.Subjectsolder patients admitted as emergencies.Methodsdiagnostic patient flow analysis followed by a series of Plan Do Study Act cycles to test and implement changes by a multidisciplinary team using time series run charts.Results60% of patients aged 75+ years arrived in the Emergency Department during office hours, but two-thirds of the admissions to GM wards were outside office hours highlighting a major delay. Three changes were undertaken to address this, Discharge to Assess, Seven Day Working and the establishment of a Frailty Unit. Average bed occupancy fell by 20.4 beds (95% confidence interval (CI) -39.6 to -1.2, P = 0.037) for similar demand. The risk of hospital mortality also fell by 2.25% (before 11.4% (95% CI 10.4-12.4%), after 9.15% (95% CI 7.6-10.7%) which equates to a number needed to treat of 45 and a 19.7% reduction in relative risk of mortality. The risk of re-admission remained unchanged.Conclusionredesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources.© The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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