Abstract
Introduction:
Older patients undergoing surgery are often living with frailty and are subsequently at increased risk of morbidity, mortality and loss of independence in the perioperative period. Accurate identification of frailty using an objective tool such as the Clinical Frailty Scale (CFS) is an imperative part of preoperative risk assessment. It also informs which patients should undergo Comprehensive Geriatric Assessment (CGA) by our Perioperative care of Older People undergoing Surgery (POPS) service.
Method:
The POPS team provided training to Surgical Assessment Unit (SAU) triage staff over a week-long period, including how to calculate and record the CFS electronically for all patients age 65 and over presenting to the unit. Once embedded, accuracy was assessed by comparing triage staff CFS scores with those calculated by the POPS team.
Results:
Fourteen SAU staff members received training. There has been a 20% initial increase in the CFS scoring compliance from 22% to 42%. Compliance has been variable and impacted by several factors including relocation of the unit and new staff members. At its peak compliance was 67% - attributed to a change in data entry procedure with the ward clerk entering the score following triage, which improved electronic capture. CFS scoring accuracy was reviewed over 7-weeks. Of the 39 CFS scores compared there were 5 matches, 8 non-matches, 19 without a CFS recorded by triage staff and 8 not recorded for other reasons. All of those not matching were underestimated by up to three CFS scoring intervals.
Conclusion:
There has been an increase in CFS scoring compliance within SAU. Further improvement work is required to increase the number being assessed and improve the accuracy of scoring. Further staff training, initiation of a ‘frailty champion’ in SAU and visual prompts including a display board are planned to increase and sustain CFS compliance and accuracy.