With the number of older people increasing in our population, the need to ensure that they receive appropriate care in our healthcare system also increases. Our ‘Improving Care for Older People in Acute Care’ workstream is a two-year programme to improve the care for older people in acute care. This work complements the scrutiny programme currently taking place to identify strengths and areas for improvements across hospitals in NHS Scotland.

Background to the programmes work

This workstream focuses on 2 key areas:

  • care co-ordination – focused on identification and immediate management of frailty
  • cognitive Impairment – focused on identification and immediate management of delirium

Here’s more information on these key areas:

Frailty and Delirium


By identifying frail patients on admission to acute care, our aim is that those patients receive timely comprehensive geriatric assessment and input from a specialist team on the day of admission. Our programme focuses on this because evidence shows that appropriate and timely screening:

  • assessment reduces length of stay in hospital
  • improves patient experience


Older people and people with dementia, severe illness or a hip fracture are more at risk of delirium. We have developed a care bundle for identifying and caring for people with delirium and it is being piloted within NHS boards in Scotland.

Delirium is a medical emergency and carries a high level of mortality. The prevalence of delirium in people on medical wards in hospital is about 20% to 30%, and 10% to 50% of people having surgery develop delirium. Evidence shows that people who have delirium may need to:

  • stay longer in hospital or in critical care,
  • have an increased incidence of dementia,
  • have more hospital-acquired complications, such as falls and pressure sores,
  • be more likely to need to be admitted to long-term care if they are in hospital,
  • be more likely to die.

Taking a collaborative approach to improving care

Working together is the key to improving care for older people. This workstream engages with healthcare teams from acute hospitals across Scotland, coming together for a series of events and webex calls to:

  • introduce new tools for testing locally with the aim of improving screening for frailty and improving the early management of delirium
  • share experience, expertise and examples of good practice in improving care for older people
  • build capacity and capability for improvement
  • support local improvement work.

Older People In Acute Care Improvement Programme resources

Link to the programmes website – http://www.healthcareimprovementscotland.org/our_work/person-centred_care/opac_improvement_programme.aspx

About the Author:

Pete Gordon
Nurse by background and pragmatic improver. Member of the NHS Emergency Care Intensive Support Team (ECIST). Passionate about doing the right things to improve patient care. @PeteGordon68


  1. dandavid 17 May 2017 at 8:50 am

    Hello Pete
    Sound like an excellent forward thinking programme. Just wondering within your organisation do you have any tissue viability issues regarding movement of elderly frail patients. Just wondering if you have any thoughts on this. We have recently innovated a slide sheet which reduces patient harm for all patients and especially for elderly frail patients. I am attaching the link for our innovation below.


    I understand this product is available through the Scottish procurement board.

    Like you we care about ,reducing harm,and improving patient care and experience.

  2. Pete Gordon
    Pete Gordon 17 May 2017 at 6:15 pm

    Hi Daniel,

    I put this on the site a while ago for Scottish colleagues, I work in England for the Emergency Care Improvement Team. It looks like a great product. Have you seen the #endPJparalysis campaign. If you are on twitter have a look. If you are, you could put the slide sheet and include the hashtag?


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