Abstract
Background: North Middlesex University Hospital runs an outpatient frailty service offering Comprehensive Geriatric Assessment. There is a daily ‘hot slot’ for patients who may otherwise require unplanned admission if not seen within seven days. Aim was to improve slot utilisation from 50 to 100%, with appropriate admission avoidance referrals by June 2023. Empty slots result in an inefficient use of resources, increased workload in other departments and reduced opportunity for patients to benefit from the service.
Methods: We audited hot slots in November and December 2022, marking slots as ‘filled’ or ‘unfilled’. In January 2023 we established a clear referral process for hot slots, implemented an education programme to increase awareness of the availability and referral criteria, and increased Consultant availability in the department. We then re-audited the hot slots from February to April 2023 and analysed data, conducted statistical testing and produced visual representation of the data.
Results: After exclusion of periods where hot slots were closed (n=13) including industrial action, bank holidays and times with below minimum staffing; 82 slots were audited, pre-intervention (n=39) and post-intervention (n=43). The utilisation of hot slots increased from 51% pre-intervention to 86% post-intervention. Fisher's exact test showed statistical significance (p<0.0007). Intervention did not improve appropriate use of hot slots (41% to 35%).
Conclusions: Interventions increased utilisation of hot slots but fell short of the targeted 100% utilisation rate. We plan to make the hot slot available exclusively to the Geriatric Emergency Medicine (GEM) team for one week in August to assess whether this increases utilisation of the hot slot. We intend to further analyse the data to review the appropriateness of referrals and help identify other ways to improve this. We anticipate our service will expand frailty frontline provision plans to help meet rising need for urgent outpatient frailty care.