ABSTRACT
Introduction: Evaluation of Wythenshawe Hospital's Acute Frailty Service in January- June 2019 demonstrated slow referrals times and poor identification of frail patients due to inaccurate Clinical Frailty Scoring (CFS) at emergency department triage. This project presents the Results: of ongoing quality assessment of our service between June 2019- January 2021, following two quality improvement (QI) interventions. Aims: To evaluate our service's ability to deliver early identification and intervention for complex frail patients via Complex Geriatric Assessment (CGA), as set out in National and Regional Frailty standards.(1,2). -To improve and maintain better outcomes for patients accessing our frailty service. Method: Intervention1 (July'19): Specialist frailty nurses relocated to ED. Dedicated frailty clinical fellows and Consultant geriatrician input 0900-1700 weekdays. Intervention2 (Sep'20): Short-stay frailty unit opened. Junior clinical fellow cover increased (0900-1900 weekdays and 0900-1700 weekends). 299 patients seen at intervals between Jun'19-Jan'21 analysed using electronic records and completed CGA proformas. Results: Pre-intervention Intervention1 Intervention2 June'19(n = 22) July'19(n = 198) Nov'19(n = 25) Sep'20(n = 26) Jan'21(n = 28) Time from triage-to-CGA (mins) (CI 95%)∗ 372.0±178.2 56.0 83.4±31.0 72.9±35.7 48.4±20.0 Discharge(%): Same day 22.7 39.4 21.7 36.0 25.0<72 hr(cumulative) 72.7 63.6 47.8 68.0 57.1 Ave. length of stay(days)(CI95%) 10.4±5.9 20.6 20.0±8.7 7.1±3.4 5.4±2.1 Readmission <30 days(%) 30.0 9.0 17.4 12.5 25.0 CGA Quality(%) CFS completion 100 96.0100 89.3 ReSPECT discussion 29.3 64.0 61.5 67.9 Full medication review 46.5 96.0 80.8 89.3 Therapy assessment 85.5 92.0 92.3 89.3 ∗patients triaged between 0800-1700. Conclusion: Since Intervention1,Wythenshawe frailty service has sustained a reduction in triage-to-CGA time, maintained high percentages of same-day and<72 hr discharges, and sustained high rates of CFS completion and therapy assessments. Following intervention2, average length of stay reduced. Increased readmission rates in Jan'21 were impacted by COVID-19. Additional interventions targeted at reducing readmission rates and increasing ReSPECT discussions should be implemented. 1. GreaterManchester Frailty Collaborative and Network, 2019. 2. Same-day acute frailty service, NHS improvement, 2019.