Improving inpatient frailty identification and its impact on Advance Care Planning.

Introduction:

Clinical frailty scale (CFS) is used to generate a score ranging from 1 (very fit) to 9 (terminally ill) for people aged ≥65 years. A CFS of ≥7 correlates with a one-year mortality rate of ~50%, making it useful for identifying individuals potentially approaching last year of life. NICE recommend this patient group are offered Advance care planning (ACP). ACP is paramount to ensuring individuals receive high-quality, personalised end of life care. We aimed to investigate CFS documentation and frequency of ACP discussions following educational interventions.  

Methods:

We performed a retrospective analysis of all inpatients admitted to an Elderly Medicine department on a given day. Data for demographics, documented CFS score, and ACP discussions was collected. CFS scores were recalculated to assess accuracy. Following formal education sessions on CFS documentation and ACP delivered to the MDT, data was recollected. Subsequently, CFS scores were recorded within electronic “flowsheets” to ensure scores could automatically populate future clinical notes and be extracted for research purposes. 

Results: 

The initial sample included 61 patients with 52 in the repeat sample. 36% of patients had CFS recorded in the initial sample compared to 77% in the repeat. In the initial sample, there was an 18.1% difference in documented and recalculated CFS for patients with a CFS≥7 compared to 7.7% in the repeat, showing improved identification of advanced frailty. In the initial cohort, 18% had pre-existing ACP and 16.4% had inpatient ACP discussion, compared to 21.2% in the repeat with pre-existing ACP and 15.4% having inpatient ACP discussion; demonstrating minimal difference. 

Conclusions: 

CFS documentation improved highlighting effectiveness of education involving the whole MDT to better identify frailty within the inpatient setting. Despite this, ACP discussion rates remained low. Potential barriers include time-pressure and lack of confidence approaching ACP demonstrating a need for further awareness and training.