UZ Leuven is the largest teaching hospital in Belgium. It also has a renowned geriatric outpatient facility: the ‘fall clinic’, which cares for over-65s who have had serious falls or who have experienced balance problems and issues with coordinating their walking. UZ Leuven’s emergency department also accommodates patients aged over 75 who have acute problems associated with ageing. Not only do patients receive treatment, but they are also given maximum proactive monitoring. We spoke to Dr Johan Flamaing, head of the gerontology department.

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Care innovation: leaders and followers

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Johan’s job is multidimensional: ‘I am responsible for the medical staff and spend time drawing up policy plans. As a geriatrician, I have responsibility for patient care, as well as assisting with training, research into geriatric (care) and so on. Clinical care is the area closest to my heart, which is why I am involved in care innovation.’ Which is no easy matter with the many research groups working at the hospital: ‘We deliver some significant results and have had some 224 publications to our credit over the past 5 years. The challenge is to obtain structural financing so that higher care quality is kept up to the mark.’

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Complex pathology, uniform solution

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Pyxima helps to achieve these aims: ‘We are seeing increasing numbers of patients with complex pathologies, which means we are dealing with more disorders and complaints. We examine the functional problems as well as the medical aspects of our cases. Physical, mental, social, dietary, medicinal: evaluating and following up on everything structurally requires greater standardisation and uniformity.’ Johan and his colleagues were already aware of Pyxima: ‘We developed a number of RAI instruments together for dealing with emergencies and the issues surrounding falls. Emergency admissions are the gateway to hospital care. But they tend to be too urgency-focused and don’t take the patient’s whole pathology sufficiently into account.’

 

Targeted care: fewer (re-)admissions

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Pyxicare is the perfect standard, according to the professor: ‘We need a form of triage in addition to emergency triage so that we can allocate an emergency for each person. Is the classic approach sufficient or would a broader evaluation be better?’ Being holistic is very important in geriatrics: ‘Our emergency case is allocated a geriatric nurse and in any case his colleagues are more vigilant in the way they deal with older patients.’ 30% of emergency cases among the elderly are not admitted to hospital: ‘They also have to be cared for and monitored in a more targeted way. That way there are fewer re-admissions and more people are able to remain in their own familiar surroundings. At the moment, 20% are re-admitted within the month.’  

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Communication with results

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Putting out fewer fires, working more preventatively? Johan nods: ‘Communication to first-line care needs to be better, which is why we work with the homecare organisation White-Yellow Cross and the CM health fund. Our case manager consults with patients and their families so that emergency recommendations can be implemented. This is also the case in the fall clinic, because incidents involving falls are high on the agenda in care centres and home situations.’ Preventing falls is particularly important: ‘Previously we gave patients lots of advice, but no more than that. Now a fall coach tests things to see if the suggestions we make are feasible. Since that has been happening, falls and serious injuries have declined markedly.’

 

 

Proper evaluations and priorities

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So how is Pyxicare used? ‘All sorts of factors lead to a fall: strength, balance, eyesight, medication, footwear, mental state, environmental factors, etc. All of the parties involved log into Pyxicare using standard evaluations. They are then able to make adjustments, carry out re-evaluations and so on. That way we are able to achieve continuity in communication to the front-line carers, which is really positive.’ The fall clinic works within short timeframes, as well as with emergencies: ‘But the patient numbers are smaller, which means that problems can be looked at in greater depth. Pyxicare also ranks advice and recommendations according to priority.’

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Innovation with ambition

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Johan sees immense possibilities: ‘Currently we are only doing 4 fall assessments per week. But this pilot project can still generate enormous results in first-line care, homecare and retirement homes. We now intend to validate our results in conjunction with other fall clinics. That way they can become the standard.’ In the meantime, Pyxicare is not standing still: ‘Our evaluation data is entered by Pyxicare into KWS, our electronic patient records. The system is much more dynamic than KWS because it is more visual and practical, again thanks to using tablets. It contains all of the interdisciplinary (inter)actions and even features instruction videos that provide advice on the right professional instruments to use.’

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Daring to re-evaluate and… reorganise

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Johan’s provisional conclusion after 2 years? ‘My people can’t do without it; it has become part of what they do. We can dare to evaluate additional points and withdraw decisions where necessary. If a pelvic fracture does not require an operation, the surgeon sends the elderly person home. Because of this, the person then comes back again because he can’t walk and the people around him have to carry the burden. Now we work with geriatricians, surgeons and cardiologists, which results in less time in hospital and fewer complications and deaths.’ The RAI standard here is crucial: ‘Everyone enters data and communicates in the same way, which saves a huge amount time when making enquiries. The benefit is enormous. You don’t get hit with a setback thanks to detailed patient records that contain proven data.’

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