Abstract
Background
Frailty Same Day Emergency Care (FSDEC) is a service designed to identify and manage frail older people at the hospital front door with a view to provide early Comprehensive Geriatric Assessment, implement management and where appropriate support a same day discharge home.
Introduction
In September 2023 the FSDEC service opened with 6 assessment spaces adjacent to A&E. This project aimed to quantify the rate of re-admission for patients seen in FSDEC and explore approaches to improve performance.
Methods
This QIP utilised a PDSA approach. Baseline re-admission data was collected from a 2 week period in October 2023. Notes were reviewed for all patients seen in FSDEC during this timeframe and reviewed for evidence of any 30 day emergency re-attendances. Cases were then reviewed to identify any links between the 2 attendances and any preventative measures that could have been taken. Following PDSA cycle 1 frailty nurse telephone follow up was implemented. PDSA cycle 2 was a stress test of this (limited) service during winter pressures. PDSA cycle 3 followed expansion of Community Integrated Response Hub (CIRH) and discharged patients being able to self-refer for support once discharged.
Results
FSDEC 7 day re-attendance reduced from 10% to 5% after introduction of frailty nurse follow up. This was not sustained over challenging winter months with variable staff availability but did recover in Summer 24. There has also been a gradual improvement in 30 day re-admission by PDSA cycle 3 following roll out of self-referral to CIRH.
Conclusion
Emergency re-admissions have reduced following implementation of frailty nurse telephone follow up and expansion of community services including patient access to CIRH for help following discharge from FSDEC. Addressing staffing model could allow for a more consistent follow up service. There is scope to trial this approach on geriatric ward discharges.