1077 ASSESSING THE IMPACT OF A 7-DAY EXTENDED HOURS NURSE PRACTITIONER LED FRONT-DOOR FRAILTY SERVICE

Abstract

Abstract Older frail patients have a demonstrable risk of adverse outcomes following attendance to the emergency department (ED), such as functional decline, delirium, institutionalisation, and death. With an increasing number of frail patients within the population, it is important to have a system of identification of these patients at the ‘front door’; with Comprehensive Geriatric Assessment and direction to most appropriate place of care, whilst simultaneously minimising impact on flow within ED departments that are under increasing amounts of pressure. Northumbria’s Frailty Assessment Service (FAS) operates 7 days a week, 12 hours/day into the ED. It identifies, within an hour of arrival, those frail patients >65 and delivers Comprehensive Geriatric Assessment and ‘ward level’ care within 4 hours, using a peripatetic model. It aims to reduce unnecessary hospital admissions and therefore potentially adverse outcomes within this group, whilst minimising impact of flow within the ED, and directs the patients towards the most appropriate place of care. It is Geriatric Specialist Nurse Practitioner led, with Consultant and MDT support, such that it has a workforce that has been able to increase to match demand over the last few years. Over the course of 12 months (Jan—Dec 2021), the service saw 3,430 patients. 2,962 patients were planned by ED for admission, and following FAS review, only 1,169 were admitted acutely, demonstrating a reduction in admission rate of 39.5% across the year. 17.2% of patients were seen on a Saturday or Sunday demonstrating the need for a 7-day service. Average time patients spent with FAS within the ED was 1 h12 minutes. The service demonstrates the sustainability and effectiveness of an extended hours, non-Consultant led ‘front door frailty’ service, without significant impact on the flow within the Emergency Department.