Abstract
Introduction – NHS England have included the identification and response to frailty in emergency departments (ED) as an area of clinical priority, producing the CQUIN05. At the Oxford University Hospitals Trust (OUH) we have designed a front door frailty service and are participating in the CQUIN05 scheme. The Clinical Frailty Scale (CFS) score is recorded by nurses in ED. Following the CQUIN05 criteria, patients aged above 65 years old and scoring 6 or above on the CFS (moderately frail) are identified by the front door frailty service and a comprehensive geriatric assessment (CGA) initiated. From initial audits, we identified that CFS scores were only identifying frailer patients (correctly scoring above or below a score of 6) in 45-51% of patients seen by the frailty team. We created a simple lanyard card with the key descriptors of characteristics above and below a CFS of 6. This was in addition to regular, brief education sessions and pre-existing CFS educational posters displayed in ED. Method. We retrospectively audited patients seen by the frailty team over 4, 7 day periods and compared CFS scores with that of the ED nurse’s. We calculated the difference and whether ED’s score was correctly above or below a CFS of 6. Results. Prior to the intervention, frailer patients were correctly identified in 45-50% in those patients seen by the frailty team. Subsequent to this intervention, this increased to 65-70%. The accuracy (difference of 0) before and after remained between 16-30%. Conclusion(s). In the context of emergency care, correctly identifying groups of frailer patients rather than strictly accurate scores, is key for front door frailty services. A simple lanyard card in conjunction with brief teaching was effective at increasing the rate in which frailty was correctly identified in patients and thus referred to appropriate frailty teams.