Abstract
Introduction
An Acute Medical Unit at Morriston Hospital became geriatrician-led in July 2021. From January 2022 the unit received patients on frailty criteria for Comprehensive Geriatric Assessment (CGA). Clinical Nurse Specialists actively manage patients until discharge.
Methodology
The first phase (November 2020 -January 2021) was acute physician-led. Phase 2(September-November 2021) and Phase 3 (March-July 2022) were geriatrician-led. Phase 3 evaluates a frailty specific intake. Patient age, LOS (length of stay), number of referrals to other medical specialities and overall hospital LOS for patients admitted through the unit were analysed.
Result
The number of patients for the three phases were 496, 566 & 503 respectively. Median unit LOS increased by one day between phase 1 and 3 (p<0.01). Meanwhile, median overall hospital LOS showed a reduction from 7 to 5 days between phase 1 and phase 2 (p<0.01) and between phase 1 and 3 (p<0.05). For patients >80 years old, the median LOS overall has reduced from 12 days in phase 1 to 7 days in phase 3 (p<0.01). There was an observed reduction in number of referrals to other specialities per bed between geriatricans (mean 0.41) and acute care physicians (mean 0.57). 50.1% of the patients who are admitted do not meet the frailty criteria set for the unit.
Conclusion
The unit has shown a LOS benefit for patients >70 years, those >80 years experience a 5-day overall LOS reduction. Identifying frail patients who may benefit from CGA is essential for individuals and overall system efficiency. However, patient selection is difficult to achieve with usual bed management processes. Morriston Hospital has developed a modified electronic screening tool based on the Hospital Frailty Risk Score (HFRS). This is embedded into the digital patient management system. It is hoped that this can be utilised to improve access to CGA for older patients