Background: People living with frailty account for a significant proportion of hospital inpatients and are at increased risk of adverse events during admission. The understanding of frailty remains variable among hospital staff, and there is a need for effective frailty training across multidisciplinary teams. Simulation is known to be advantageous for improving human factor skills in multidisciplinary teams. In situ simulation can increase accessibility and promote ward team learning, but its effectiveness with respect to frailty has not been explored. Method: A single-centre, multi-fidelity, inter-professional in situ frailty simulation programme was developed. One-hour sessions were delivered weekly using frailty-based clinical scenarios. Mixed-method evaluation was used, with data collected pre- and post-session for comparison. Results: In total, 86 multidisciplinary participants attended 19 sessions. There were significant improvements in self-efficacy rating across 10 of 12 human factor domains and in all frailty domains (p < 0.05). The common learning themes were situational awareness, communication and teamwork. Participants commented on the value of learning within ward teams and having the opportunity to debrief. Conclusion: In situ simulation can improve the self-efficacy of clinical and human factor skills related to frailty. The results are limited by the nature of self-reporting methods, and further studies assessing behavioural change and clinical outcomes are warranted.

Simulation-based education has an established role in the training of healthcare professionals. Annually, a mandatory simulation course is run for foundation doctors at a London teaching hospital. Nurses and allied health professionals (AHPs) are also invited as ‘staff that work together should train together’ [1]. The COVID-19 pandemic resulted in fewer learning opportunities, and attendance from nurses and AHPs was subsequently reduced on the 2021–2022 programme. The aim was to bring attention to, create discussion, and offer solutions to address the ongoing barrier of the pandemic to effective interprofessional education (IPE). Pre- and post-course questionnaire responses were collected via SurveyMonkey using the Human Factors Skills for Healthcare Instrument (HuFSHI) [2] and clinical-based questions. These were paired anonymously with mean improvements calculated for each. The post-course questionnaire contained free-text questions. 23 courses were scheduled but 7 were cancelled due to poor attendance. There was a lack of nurses and AHPs signing up (153 doctors, 22 nurses, and 8 AHPs). Overall, 100 learners attended, consisting of 91 doctors, 8 nurses, and 1 AHP. The low proportion of nurses and AHPs was commented on by medical participants in their feedback. Of the 16 courses, 9 were attended solely by doctors and 5 sessions had only 1 nurse/AHP. The course was well received with positive average change scores across the 12 HuFSHI questions and clinical-based questions. Whilst results show the course had a positive influence, the lack of nurses and AHPs meant the known value of IPE was diminished. As training is linked to improved resilience and wellbeing [3], nursing and AHP staff missed out, creating disparity across professions. This is significant following the impact of the pandemic on training and wellbeing – which this piece suggests is ongoing. Formal data was not collected regarding the reasons for poor attendance, but cancellation of nurse’s study leave across the Trust for a short period, plus covering isolation and sickness were likely contributing factors. Unexplained non-attendance on the day proved the most challenging although contacting participants beforehand combatted this to some degree. There are plans to introduce a text reminder system for next year. Proactive and integrated planning with stakeholders has enabled the early release of dates for next year, with doctors allocated automatically to sessions to promote a balanced spread of professions represented. Alternatively, in-situ simulation provides another way to increase accessibility and attendance. 1. Ockenden D, 2022. Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Final Report. London UK: Department of Health and Social Care. 2. Reedy GB, Lavelle M, Simpson T, Anderson JE. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing inter-professional learning across healthcare practice settings. BMJ Simulation & Technology Enhanced Learning. 2017;3(4):135–141. 3. Brennan EJ. Towards resilience and wellbeing in nurses. British Journal of Nursing. 2017;26(1):43–47

Introduction The ability to recognise and manage frailty and its associated presentations is variable among acute hospital staff. Patients living with frailty who are admitted to hospital are more likely to suffer adverse effects than those without. We created an inter-professional in-situ simulation programme designed to improve recognition and management of frailty and its common adverse events. The programme objectives align with recommendations from the British Geriatric Society’s ‘Frailty Hub’ and Royal College of Physicians’ ‘Acute Care Toolkit’ for frailty. Method Over a two month period, seven sessions were completed on the Older Persons Unit (OPU) at St Thomas’ Hospital. These comprised a simulated scenario followed by facilitated debrief—including technical skills and human factors highlighted by the scenario. Quantitative data was collected through pre and post session questionnaires using the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty based questions. Post session qualitative data was also collected. Results 30 participants attended the sessions (nursing, medical and allied health professional). All participants completing the post course questionnaire found the sessions useful. When comparing pre and post session data, participant confidence in 10/12 sections of the HuFSHI and 8/9 frailty based questions demonstrated improvement. The qualitative data showed common learning themes around improved communication, teamwork and escalation. Participants found that the sessions were a valuable ‘opportunity to reflect’ and ‘debrief’, and learn together as a multidisciplinary team. Conclusion In-situ simulation is an effective tool for improving knowledge and confidence in managing frail patients. It increases awareness and understanding of human factors, which are key to the multidisciplinary approach frail patients require. The course is being expanded across the OPU and now has funding for a departmental manikin. The programme can be disseminated to other units to help improve the care and safety of those with frailty in hospital.

Awareness of symptoms associated with frailty is uneven across acute hospital staff The aim of the study was to evaluate the efficacy of simulation was selected to increase accessibility for staff and promote ward team learning. Sessions started in October 2020 on one ward, before moving across other wards. These 1-hour sessions have been delivered weekly with a hiatus due to the second wave of the COVID-19 pandemic. A bank of frailty-based scenarios has been created, ranging from acutely unwell patients to communication with families. Participants have been from across the multi-disciplinary team. Data were collected using pre- and post-session questionnaires – containing the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty-based knowledge questions with Likert scales. Learning has been disseminated through the department via newsletters.Thirteen sessions have been delivered with 59 participants (23 nurses, 20 doctors, 9 physiotherapists, 6 nursing assistants, 1 occupational therapist). Forty-nine surveys were completed – 100% of participants found the sessions useful. Post-training, staff demonstrated improvement of self-efficacy in 11/12 HuFSHI questions and all frailty questions (Table 1). The most common learning themes were communication (51%), teamwork (43%) and escalation (24%), as well as management of frail patients (35%). Working with the team (47%), the scenarios (18%) and debriefing (12%) were aspects learners most liked about the sessions.An

Introduction Increasing old age and frailty is putting pressure on health services with 5–10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, with more timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes.