From Care Home to the Emergency Department; a Snapshot of Frailty Admissions

Background: Care home residents form a large number of admissions to Emergency Departments (ED) across the UK. Over an 8-month period we reviewed care home admissions to ED to provide further insight on these admission types and identify ways to improve care.

Method: All patients with a frailty score of 6 or more admitted from care homes to Chelsea and Westminster Hospital ED between 1^st June 2022 and to 31^st January 2023 were included. Data was collected from the hospital computer system and London Ambulance Service (LAS) attendance sheets. Information collected included; care home the patient resided at, LAS attendance times at scene, if discussion with a Health Care Professional (HCP) prior to attendance had occurred, Presenting Complaint (PC) and Length Of Stay (LOS). We then sub-categorised data accordingly.

Results: There were 180 patient admissions from 34 care homes. 34% (N=61) of LAS attendances occurred during normal working hours (9am-5pm Monday- Friday) with only 43% (N=26) of patients being discussed with an HCP prior to admission. Of these, 30% (N=18) were discharged <24hrs and subjectively 39% (N=7) did not require ED admission. Out of hours (OOH) attendances formed 66% of admissions, with most common PC being fall (33%, N=59) followed by respiratory issues (22%, N=38). Overall admissions accounted for 454 bed stay days.

Conclusion: Discussing patient’s with an HCP prior to contacting LAS would reduce ED admissions alongside accessing rapid response team more frequently. Expanding an HCP accessible service OOH would be necessary to facilitate this and implementing a frailty telephone service from Chelsea and Westminster may be one solution. Focusing on individual care homes and working with community teams form the next steps in this review.