Intensive Care COVID positive admissions and outcomes in relation to frailty parameters

Introduction: Frailty assessment using the Clinical Frailty Scale (CSF),1 has been incorporated into COVID decision aids;frailty highlights risk of poor outcome which can guide future care.2 The ITU patient population has trended towards a younger, fitter and less co-morbid population.3 Yet COVID is a disease that disproportionately effects the elderly;people aged over 65 years represent more than 50% of ITU admissions and account for 80% of mortality.4 There are subsequent ethical considerations as to how resources were and continue to be allocated;an understanding of how frailty has impacted clinical decisions can drive improvements in future practice (5). Frailty has sustained relevance in a critical care environment with continual scarcity of resources.3 Objectives: To undertake a service evaluation of the mortality and hospital outcomes of positive COVID patients admitted to Ysbyty Gwynedd ITU from 01/03/2020 to 01/06/2021. To consider the effect of measured preadmission frailty of patients on ITU admissions and outcomes. Method: Service evaluation of outcomes for patients testing positive for COVID-19 and admitted to Intensive Care. Patients aged 18 or over were considered eligible for the evaluation and patients with suspected COVID that tested negative were excluded. Retrospective data was sourced from the ICNARC database, handover notes and clinical files. CFS scores were used to dichotomise the cohort into two distinct groups;one group with CFS scores 1-4 was defined as fit or vulnerable and the second group scoring between 5-9 was defined as frail. Patients were then assigned a pandemic 'wave' based on their date of admission: admission between 01/03/2020 to 01/09/2020 were assigned 'Wave 1' and between 01/09/2020 to 01/06/2021 'Wave 2'. Results: 72 COVID patients were included in the service evaluation;65% of patients were male, the mean age was 59 years (SD 13) and the mean ICNARC score was 13.4 (SD 6.8). The overall in-hospital mortality was 30.6%. The frail group of patients experienced worse outcomes than their fitter counterparts;in-hospital mortality rate was higher (35.8% vs 29.3%), mean LOS in survivors longer (25 vs 17 days), and ventilator use more frequent (64.3% vs 46.6%). The average CFS score of the admitted ITU patient increased over time (see Figure 1). InWave 1 5.9% of admitted patients were classified as frail compared to 21.8% in the Wave 2. Conclusions: Frailty is a useful tool to highlight risk of poor outcome in COVID patients. A higher proportion of frail patients were admitted in Wave 2;this could indicate a greater confidence to treat this patient population with fewer resource constraints. It is important to consider frailty alongside broader clinical information for use in clinical decision making regarding ITU intervention and subsequent pathways of care. Frailty might be an important tool to ensure care does not disadvantage those who can be considered both fit and elderly.

Transforming a university library into a learning organisation

PurposeThe purpose of this study is to discuss the strategies to promote a culture of professional learning within an Australian academic library. As the COVID-19 experience has shown new and evolving roles require skills, knowledge and abilities that current library employees may not have trained for. One framework which supports continuous professional development and employee motivation is the concept of a learning organisation, where staff across all levels of the library acknowledge the value of continuous learning and autonomously engage in activities to keep their skills up to date and relevant.Design/methodology/approachThe article is a case study of a three-year period of interventions and outcomes in an Australian academic library.FindingsThe strategies discussed provide insights for library managers and leaders about how organisational change can be incrementally embedded through clarity of purpose, aligned leadership, transparent processes, self-determination and social learning.Research limitations/implicationsThe case study examines a single institution.Originality/valueThe paper provides practical strategies and examples from the case study of one university library which has successful embedded workplace learning as a regular and accepted part of staff routines.