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Roberta Dewar, Emma Swinnerton, Claire Ingham, Tim Pattison, Jenny Fox, Louise Butler

Salford Care Organisation, Northern Care Alliance

Abstract

Background:

The UK has an increasingly frail ageing population, with rising numbers presenting to Emergency Departments (ED’s), with subsequent admission to hospital wards. Older adults living with frailty have longer waiting times in ED’s, are more likely to be admitted and have longer lengths of stay.

Introduction:

The NHS Long Term Plan requires hospitals to provide an Acute Frailty Service (AFS) for at least 70 hours/week and complete a Clinical Frailty Score (CFS) within 30 minutes of arrival3 . The plan also advocates Same Day Emergency Care (SDEC) to reduce admission related harms and discharge patients in a timely way4 . The introduction of an acute frailty CQUIN stipulating prompt identification of frailty and initiation of CGA is another driver for the development of AFS5 .

Method:

An Acute Frailty SDEC Team was established, including an Acute Frailty Nurse, Clinical Fellow, Advanced Clinical Practitioners and GPs. The team was present in ED on weekdays between 9am-5pm, with 1-2 team members on each shift. A Consultant Geriatrician was also available to provide advice and support. A Frailty SDEC inclusion criteria was recommended as follows:

- Age >=65years with CFS>=5

– NEWS<3 - Triage note suggests patient may not need hospital admission> <3

- Triage note suggests patient may not need hospital admission

Results:

Over a 4-month period, 262 patients were seen by the SDEC team. Age and CFS score for this population are shown in Figure 1 and 2. 74% were seen within 2hours as demonstrated in Figure 3.

131 (50%) of patients were discharged directly from ED (Figure 4). A further 25 (15%) of patients were later discharged from EAU.

Conclusion:

An Acute Frailty SDEC service results in early identification of frailty, timely assessment in ED and a high likelihood of discharge (60%) directly from ED or EAU rather than being admitted to an inpatient ward. Implementation of a 7 day service would only serve to increase these figures.

Developing an Acute Frailty SDEC Team at Salford Care Organisation

Abstract