Abstract
Aim:
There been several studies validating the Hospital Frailty Risk Score (HFRS) to identify frailty. (1),(2). We proposed that it could identify patients in the Emergency Department (ED) who would benefit from the Older Persons Assessment Service (OPAS).
Methods:
OPAS is an ED service which accepts patients on frailty criteria (aged >70 years, falls, confusion, care dependence, polypharmacy and poor mobility). A retrospective analysis of the OPAS databank was conducted using HFRS to divide patients in High/Intermediate and Low Frailty Risk. We considered Age, Clinical Frailty Score (CFS), Post-code with Deprivation Index and death within a year of attendance.
Results:
700 admissions: 400 High/Intermediate HFRS and 300 Low HFRS. High/Intermediate HFRS: 170 (42.5%) male, mean age 83.69 years, CFS 5.7. Low HFRS: 102 (34%) male, mean age 81.46 years, CFS 4.5. High HFRS vs Low HFRS had similar deaths (p=0.2) but a significant difference in CFS (p<0.05). HFRS was significant at detecting frailty in those <75 years old (p<0.01) but not at >76 (p=0.08). There was no association between the Welsh index of multiple deprivation with Frailty or Death. The HFRS Sensitivity is 0.44, Specificity 0.83, Positive Predictive Value 0.66, Negative Predictive value 0.34, Area under the curve 0.39 vs CFS.
Conclusion:
The HFRS identified 57% of the retrospective OPAS cohort, with the addition of >80yrs of age, the modified score identifies >85% of service users. We found that controlling for socio-economic status, quality of discharge summaries and coding had no relationship to the efficacy of HFRS as a screening tool. We have developed an electronic, automated Frailty Flag that operates in real-time to signpost appropriate patients who would benefit from OPAS, Orthogeriatric or POPs services (this facilitates patients to be ‘flagged’ for review as stated within NELA.) The Frailty flag is currently being tested in clinical practice.