Abstract
Introduction: Across the UK, emergency and assessment units are faced with the challenge of streamlining urgent care services which best meets the requirement of older frail patients.
Method: Patient pathways were mapped using real-time and retrospective data collected from the notes of 30 frail patients over 75 admitted to ED under medicine. Frail patients were identified by the Frailty Intervention Team, and patient demographics were noted. Key touchpoints and the date/times of initial treatment and investigations were documented. Experience questionnaires produced by the Acute Frailty Network were completed to capture the perspectives of 38 frail patients over 75.
Results: Of the 30 patients admitted to ED, 21 (70%) had cognitive impairment and 16 (53.3%) patients had a frailty score (FS)>4. The median time spent in ED/AU for the cohort was 95 hours 31 minutes (approx. four days). The median trolley wait for the cohort was 30 hours 42 minutes (IQR 17hr 42 min-48hr 22 min), 34 hours 22 minutes for patients with cognitive impairment and 28 hours 17 minutes for patients with FS>4, which were significantly longer than the one-hour Silver Book standard. Of the patients admitted during the day, the CGA was performed within 24 hours 9 minutes (IQR 21hr-41 hr) of admission, which does not meet the Silver Book standard of one hour. The median number of night transfers within ED/AU was 1, with 51.5% done at night. Questionnaire results highlighted suboptimal environments, with over 50% of patients feeling indifferent or unhappy during admission.
Conclusion: Both quantitative and qualitative data demonstrated challenging patient journeys in ED/AU. The crowded and busy environment of ED/AU needs to be more conducive to addressing the complex needs of frail individuals. Establishing an acute frailty unit within ED would provide rapid patient-centred care for frail patients.