Developing our Older Peoples Liaison Service: Is a Frailty nurse led model the way forward?

Introduction ‘Older People in Hospital Standards’ (2015) identifies that Older People should have care/treatment in the most suitable settings. In University Hospital Monklands (UHM) a liaison service was provided to frail patients who needed care outwith our older peoples’ wards (eg Surgical wards), led by clinicians (Consultant Geriatrician/ specialty doctor) twice weekly with support from Frailty nurses (FN). Patients were referred via multiple routes (email, letter, phone). Our aim was to develop a single point of referral, to increase capacity, be more responsive and FN led. Methods: We developed the FN workface by recruiting advanced/ trainee advanced nurse practitioners. We developed an electronic referral and Electronic Frailty alerting in October 2022. We provided education/visual prompts about the service and embedded the referral pathway/criteria in the hospital ‘huddle’ and safety briefs. From December 2022, all patients referred were reviewed by a FN. Results: From December 2022, the number of electronic referrals has increased by 70% ( fig 1). The number of patients who have a recorded clinical frailty score (CFS) has increased from 50 % to 98% ( fig2) We now have a 5day service, where referrals are seen the same day by FN. We reduced the need for clinician input from 2 sessions/week to 0.5 sessions/week, allowing redistribution of workload. There has been no change in outcomes of discharge planning/rehabilitation/repatriation for patients before and after the change. Conclusion: The number of referrals made electronically has increased – allows a more responsive service, standardises the pathway and reduces FN time in responding to phone calls/emails. This has increased the number of patients who have a CFS completed. It has released clinician time to deliver care in other parts of the system. Ongoing plans include developing this to be fully FN led and using it in planned care eg in preoperative admissions.