Abstract
Background:
An estimated 10% >65-year-olds and 25-50% >85-year-olds live with frailty in the UK, 1 making up a greater proportion of surgical caseloads. Perioperatively, frailty is an independent risk factor for adverse outcomes.2,1 Timely recognition and assessment is vital in prevention, however, awareness of frailty and the Clinical Frailty Scale3 (CFS) is limited amongst clinicians.4
Methods:
A survey was completed by doctors of all grades across surgical specialties in Sandwell General Hospital. Questions explored recognition of frailty, use of CFS, and their influence in perioperative decision making.
Results:
A total of 33 Doctors completed the survey (33.3% Junior Doctors). Whilst 97% believed they look after frail patients, 69.7% were aware of the CSF but only 30.3% had used the scale.
All doctors thought frailty plays a role in their decision making post-operatively, however >87% rated their confidence in recognising frailty ≤3/5.
Key Messages:
Across all grades, there is an awareness of the importance of frailty, however a lack of confidence in its recognition. Need for further education is evident, particularly regarding the CFS. In this respect, focused education sessions are being implemented for all grades of doctors to consolidate knowledge and facilitate a multidisciplinary approach to decision making in surgery
Comments
You've recognised that many people identify that they treat "frail" patients and it alters there decision making, but the minority use a standardised score for assessing this-I assume they are basing it on an "end of the bed" assessment? How do you intend to convince senior colleagues of the importance of a more formal documentation of frailty status? Who is best placed to be assessing the level of frailty? How do you envisage a more formal assessment potentially leading to changes in care for these patients?
Reply to Dr Bunn
Thank you for your thoughts and questions.
From the discussions with senior colleagues following the local presentation of this audit, it has been possible to begin to open up the conversation around recognising frailty and the importance of the CFS. Senior colleagues, in particular surgeons, have responded well to this and quite quickly have begun using the CFS in their assessments, particularly perioperatively or on admission. From this very small amount of experience, it appears that these clinicians have appreciated having a formal standardised score, for example similar to NELA scoring, that helps quantify something that can be more challenging when using an 'end of bed' assessment.
Again, from limited experience, the main challenge has been less around convincing senior colleagues of the importance of formal documentation of frailty status but the use of this in guiding decision making and treatment escalation/ limitations. This is an area for further education and discussions, as well as the role of Geriatricians in surgical specialties to help facilitate these decisions.
In regards to who is best placed, locally all grades of clinicians have engaged well with the concept and importance of frailty. If we can encourage clinicians in this from the start, we will create a workforce that is more adept at recognising frailty and hopefully responding in a way that facilitates good care of the elderly. Ultimately though, Geriatricians are best placed to facilitate a more comprehensive assessment of frailty e.g. as part of a CGA, and there is much scope for Geriatricians in surgical liaison/ perioperatively.