Consultant Practitioner, Northern Care Alliance NHS Foundation Trust/Bury Local Care Organisation, Bury.
Br J Nurs. 2023 Oct 12;32(18):882-889. doi: 10.12968/bjon.2023.32.18.882.
A comprehensive geriatric assessment (CGA) provides a holistic assessment for the frail and older person. The CGA considers physical and mental conditions as well as function, environmental and a person's social circumstances. Virtual wards are a new concept within the NHS, and use of virtual wards during the COVID-19 pandemic reduced hospital admissions by 50%. The British Geriatrics Society has set clear guidelines on how virtual wards should be developed within integrated care services via multidisciplinary community rapid response teams to improve patient outcomes. This article considers a logical approach to assessing suitability for admission onto a virtual ward for a patient who required hospital-at-home services. It does this through the use of a theoretical patient case study, in this case involving delirium and urinary tract infection. Frailty and frailty scoring tools are discussed, as are the advantages and disadvantages of a CGA, considering a clear progression through the five domains. It shows how conducting a CGA allows for the development of a problem list to help prioritise the patient's problems and plan accordingly. A critical review of the literature around virtual wards, hospital-at-home services and admission avoidance identified that community rapid response teams were the logical choice to provide a multidisciplinary holistic approach to the older person admitted onto a virtual ward.
全面老年评估（CGA）为体弱和老年人提供全面评估。CGA 考虑身体和精神状况以及功能、环境和个人的社会环境。虚拟病房是 NHS 的新概念，在 COVID-19 大流行期间，虚拟病房的使用使住院人数减少了 50%。英国老年学会通过多学科社区快速反应团队为综合护理服务制定了明确的指导方针，以改善患者的治疗效果，说明如何在虚拟病房内进行开发。本文考虑了一种通过使用理论患者病例研究来评估患者是否适合接受虚拟病房住院治疗的合理方法，该患者需要居家医院服务。研究涉及谵妄和尿路感染。讨论了虚弱和虚弱评分工具，以及 CGA 的优缺点，考虑了通过五个领域的明确进展。它展示了如何进行 CGA，以便制定问题清单，帮助确定患者的问题并相应地进行计划。对围绕虚拟病房、居家医院服务和避免住院的文献进行了批判性回顾，发现社区快速反应团队是为虚拟病房收治的老年人提供多学科全面方法的合理选择。
