279Frailty in an Acute Hospital: Point Prevalence and Change in Baseline Status during Hospitalisation

Morrison, Laura; Costello, Maria; Flannery, Antoinette; Small, Cliona; Nevin, Rachel; Havelin, Alison; O’Reilly, Liam; Heffernan, Laura; Hong, You Yi; Waters, R; Spooner, Lynn; O’Keeffe, Shaun T.; Ó’Caoimh, Rónán

doi:10.1093/ageing/afx145.51

Cited by 7 publications

(7 citation statements)

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“…During winter 2017/2018, an occupational therapist (OT) was available to identify older patients with therapy needs at point of attendance. Data from this project showed a frailty prevalence of 53% (Rockwood scores 5 or above) in patients over 75 years attending ED, similar to previous work 15 16. Due to funding constraints this was not ongoing, but had proved the concept and feasibility of identifying frailty at the front door.…”

Section: Contextsupporting

confidence: 68%

The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

2019

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National guidelines mandate identification and tailored management of patients living with frailty who attend the acute hospital setting. We describe using quality improvement (QI) techniques to embed a system that allowed identification of frailty in older patients attending the emergency department (ED), creation of a clinical pathway to facilitate comprehensive geriatric assessment and appropriate same-day discharge of suitable patients. Integration of Clinical Frailty Scale (CFS) scoring within an electronic record system, a continuing programme of education and awareness, and dedicated project staff allows patients to be identified for an ambulatory frailty pathway. Our results show a sustained improvement over 9 months of the project, with 73% of patients over the age of 75 years presenting to ED by ambulance now receiving a CFS score. Over 300 patients have been identified, transferred to ambulatory care and treated via a new frailty pathway, with an admission rate for this cohort of 14%, compared with an overall admission rate of 50% for patients over 75 years. We report a decrease in overall ED admission of 1%. Analysis of patients discharged through this same-day pathway showed a 7-day ED reattendance rate of 15.1% and a 30-day readmission rate of 18.9%, which are comparable with current pathways. Consultant review estimated 87% of patients to have avoided a longer admission. Patient and staff satisfaction indicates this pathway to be feasible and acceptable to users. Our data suggest an ambulatory frailty pathway can deliver significant admission avoidance while maintaining low readmission rates. Similar schemes in other hospitals should consider using QI approaches to implementation of frailty pathways.

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Section: Contextsupporting

confidence: 68%

The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

2019

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“…In an Irish setting, the population has similar demographics and levels of frailty as similar recent studies. 72 Nevertheless, clinicians need to use their judgment when extrapolating the findings and applying them to their own context.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study

et al. 2021

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“…The risk-stratification of older adults presenting to the Emergency Department (ED) is useful to target interventions that reduce their risk of adverse healthcare outcomes [1,2], particularly where frailty is identified [3]. This is challenging because frail patients often present atypically [4,5], and acutely unwell hospitalised older adults may appear frailer than their baseline suggests [6], meaning that resource-intensive, evidence-based interventions such as comprehensive geriatric assessment (CGA) [7] can be difficult to apply. Demographic change is expected to heighten this with a greater number of older and frail patients presenting to EDs [8].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Frailty Screening Instruments in the Emergency Department

Ó’Caoimh

Costello

Small

et al. 2019

IJERPH

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Early identification of frailty through targeted screening can facilitate the delivery of comprehensive geriatric assessment (CGA) and may improve outcomes for older inpatients. As several instruments are available, we aimed to investigate which is the most accurate and reliable in the Emergency Department (ED). We compared the ability of three validated, short, frailty screening instruments to identify frailty in a large University Hospital ED. Consecutive patients aged ≥70 attending ED were screened using the Clinical Frailty Scale (CFS), Identification of Seniors at Risk Tool (ISAR), and the Programme on Research for Integrating Services for the Maintenance of Autonomy 7 item questionnaire (PRISMA-7). An independent CGA using a battery of assessments determined each patient’s frailty status. Of the 280 patients screened, complete data were available for 265, with a median age of 79 (interquartile ±9); 54% were female. The median CFS score was 4/9 (±2), ISAR 3/6 (±2), and PRISMA-7 was 3/7 (±3). Based upon the CGA, 58% were frail and the most accurate instrument for separating frail from non-frail was the PRISMA-7 (AUC 0.88; 95% CI:0.83–0.93) followed by the CFS (AUC 0.83; 95% CI:0.77–0.88), and the ISAR (AUC 0.78; 95% CI:0.71–0.84). The PRISMA-7 was statistically significantly more accurate than the ISAR (p = 0.008) but not the CFS (p = 0.15). Screening for frailty in the ED with a selection of short screening instruments, but particularly the PRISMA-7, is reliable and accurate.

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279Frailty in an Acute Hospital: Point Prevalence and Change in Baseline Status during Hospitalisation

Cited by 7 publications

References 0 publications

The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study

Comparison of Frailty Screening Instruments in the Emergency Department

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