British Geriatrics Society

Continuity of care for older hospital patients

In this 32 page document published by The King’s Fund and prefaced by Finbarr Martin, Jocelyn Cornwell et. al. draw attention to the contribution that continuity of care makes to the quality of care experienced in hospital by patients aged 70+ with multiple health problems.

Download the full paper (pdf format)

In his foreword, Finbarr outlines the following key messages:

• Continuity is fundamental to high-quality care. Without it, care is unlikely to be clinically effective, safe, personalised, efficient or cost-effective. Breakdowns in continuity of care put patients at risk, cause duplication and add avoidable costs to both health and social care.
• The paper focuses on the experiences of older people with multiple health problems, and particularly on their experiences inside hospital. Continuity is especially important for these older patients because: they are more likely to spend time in hospital and to be in hospital for longer; if they are frail, a stay in hospital can be life-changing; and, regrettably, in some hospitals and some wards older patients are exposed to unacceptable standards of care.
• The national inpatient surveys provide objective data on patients’ experiences but not on how it feels to the patients. We have presented case studies from carers, which reflect commonly reported concerns and vividly exemplify the impact that poorly co-ordinated care can have.
• Patients and carers experience problems with care planning, communication and co-ordination. Their stories show that breakdowns in continuity cause patients to lose trust; however, ordinary human respect, kindness and consideration shown on a personal level has a disproportionately positive impact on patients’ and carers’ overall sense of their experience.
• The obstacles to continuity of care for older patients in modern hospitals are systemic and complex. Issues include: the volume of work in hospital; the ordinary routines that govern the working days (and nights); the culture of care in the hospital as a whole and in teams; the levels of training and skill of the workforce; and the values of the staff. Engagement of senior staff and board members with frontline staff and with patients and carers is also critical.
• In the short term, a number of interventions can help to improve continuity of care. We outline practical models and methods for improving continuity of care and make recommendations for frontline and senior executives.