107 Improving Frailty Screening and Accuracy in the Emergency Department (Ed) of A Busy District General Hospital

Abstract

Abstract Background Over 20,000 75+ years attendances annually in ED with frailty screening in introduced in ED in 2016. Early recognition of frailty is recommended. Accurate estimation of frailty level is important as it contributes to clinical pathway and management. Introduction Screening rates had fallen and there were concerns about the accuracy.. Our aim was increased frequency and accuracy of screening at triage. Method Frailty screening rates for patients aged 75+ years attending the ED (routine measure) reviewed with ED Frailty Lead. Stakeholder engagement with ED staff and Frailty and Interface Team (FIT). Frailty screening tool revised. Data review March 2020 focused on CFS accuracy (CFS at triage v CFS by FIT in routine assessment). Sampling approach to CFS accuracy during June 2020. Interventions Small group sessions with ED nursing staff (Jan 2020). Revised electronic screening tool introduced (February 2020). Education sessions (x2) for ED nursing staff (June 2020) focused on CFS. Results Frailty screening increased significantly following revised screening tool introduction from 60% to >80%. In March 2020 agreement of CFS at triage and FIT review in 22% (76/341). The CFS reliability for 10 consecutive patients per day was measured in June 2020 before and following 2 education sessions held on CFS. The reliability of CFS was 0.23 prior to teaching in June and rose to an average of 0.31 following the teaching intervention. Conclusions Frailty screening frequency and the reliability of the CFS improved following teaching interventions but remains low. Work is continuing to focus on improving this further. Although CFS has been found to be reliable between raters in other hospitals we have found this difficult to replicate. It is not known if this is due to local factors or to more common challenges that others may face in CFS estimation by ED staff.