Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 327

To understand and improve safety and quality of care for older people, particularly those who are frail and complex, it is crucial that we consider further what safety and quality actually mean in this population. As described earlier, existing ways of measuring safety in hospitals, particularly through case record review or reporting, are not very good at detecting the complex geriatric syndromes that are important to these patients and the healthcare system. This is not surprising, considering that such measures were not originally developed with the frail older person in mind. Very few adverse events associated with poor clinical reasoning, communication skills, or safety awareness are detected by the usual methods of clinical incident reporting.

The complex nature of frail older patients can lead to difficulties unravelling cause and effect when trying to assess safety in these patients. Another complicating factor is that the boundaries are blurred between adverse outcomes of hospitalization that are not preventable, preventable adverse events, and providing high‐quality service.

Current measures of quality of care for older people tend to assess the management of specific clinical problems across healthcare sectors, such as the national audits of stroke, falls and bone health, and incontinence in the UK or the Assessing Care of Vulnerable Elders (ACOVE) measures developed in the US.⁷⁸ There is certainly a need to develop generalizable quality indicators for acutely unwell frail elderly people in the hospital, as highlighted recently by the NHS Confederation in the UK.⁷⁹