ROYAL COLLEGE OF EMERGENCY MEDICINE CARE OF OLDER PEOPLE QUALITY IMPROVEMENT PROJECT AT UNIVERSITY HOSPITAL OF NORTH DURHAM

Abstract

Older adults constitute a growing proportion of emergency department (ED) attendances and hospital admissions. Delirium, frailty, and falls represent major clinical risks in this population, yet screening and management remain inconsistent. This study evaluated a local quality improvement (QI) project at the University Hospital of North Durham (UHND) aimed at improving the assessment and management of older patients in the ED. Prospective data were collected between February and November 2024 (n = 158) using the Royal College of Emergency Medicine (RCEM) Care of Older People Quality Improvement Project (QIP) criteria and benchmarked against national data (n = 1,997).

Local outcomes demonstrated improved completion rates for falls-risk and frailty screening compared with national averages and markedly higher implementation of falls-mitigation strategies. However, delirium screening and comprehensive geriatric assessments (CGA) remained below national levels. The project also explored staff engagement, barriers to consistent screening, and follow-up interventions such as targeted teaching and a re-audit cycle. Findings highlight the value of structured QI initiatives in improving targeted care processes and outcomes for older patients while underscoring ongoing challenges in embedding systematic delirium assessment within busy ED environments.