Abstract
Introduction:
It is very often observed in clinical practice that older patients with frailty stay in the A&E for long periods under the Therapy Assisted Discharge Service (TADS) team without an appropriate referral to the medical/Frailty team. There are many potential risks identified such as missed opportunity for early geriatrician/frailty input, incomplete clinical assessment, missed opportunity for CGA, critical medications omitted, missed VTE assessment, and delay in receiving care.
Methodology:
A retrospective study of 50 patients was conducted through EPR notes at East Kent Hospitals University NHS Foundation Trust. We collected data from the A&E list daily for patients >75 years old with Rockwood scores 5 or more, who have been in A&E for >12 hours under TADS/A&E without referral to any specialty. We also looked for referrals to the medical/Frailty team, Comprehensive Geriatric assessment (CGA), regular medicine prescription, advanced care plan, successful discharge, and percentage of patients readmitted in 7 days. Following the first cycle, awareness was raised through meeting with the TADS team, educating front-door doctors to refer patients to the Frailty/Medical team within <12 hours who met the inclusion criteria.
Results:
After interventions, we demonstrated an improved result compared to the initial cycle. We achieved patient referral to Medics/ Frailty from 45 to 59% within 12 hours, Comprehensive Geriatric assessment (CGA) done 15% to 45%, medications charted within 12 hours 50% to 75%, advanced care plan 45 to 64%, successful discharge 38% to 60%. Interestingly, there was a significantly reduced percentage of patients re-admitted within 7 days which is 30% to 10%.
Conclusion:
It is unsafe to admit older patients with frailty under the A&E/TADS for more than 12 hours without any referrals to the medical or Frailty team because of many potential risks. Following a limited awareness campaign, we witnessed some improvement in some of the standards. However, there are still areas of potential improvement. To attain 100% compliance with the first recommendations of this QIP, a re-audit with increased awareness and actions is planned in a few months.
Reference:
https://www.england.nhs.uk/urgent-emergency-care/same-day-emergency-care/acute-frailty/