112 A Critical Evaluation of the VIP Tool in Identifying Frailty in the Older Adult in a Kerry Hospital

Abstract

Abstract Background The Variable Indicative of Placement risk (VIP) is a tool that was developed in Belgium to identify older people at risk of adverse health outcomes at the time of hospital admission (Vandewoude et al 2008). VIP is a simple 3-item screening tool for the selection of hospitalized patients aged 70 and older who are at increased risk of problems at discharge. It asks three simple questions about frailty factors already existing before admission. This tool has been validated to select patients who would benefit from a geriatric assessment (Vandewoude et al 2008). As part of the implementation process, it is important to critically review VIP as a frailty screening and selection tool for the Frailty Intervention Therapy Team (FITT) service compared to age criteria alone. There is a risk that patients screening negative on VIP could be inappropriately excluded from the FITT review. Methods All patients over 75 were screened using the VIP tool over a 6 week period by nursing staff in triage The “Think Frail” tool was also used to screen all patients reviewed by FITT- both positive & negative VIP Data was retrospectively gathered and VIP positive/negative patients reviewed by FITT were analysed Results 55% were VIP positive 45% were VIP negative 16.5% of VIP negative patients were screened positive for frailty using the “Think Frail” tool We found VIP under-recognised patients presenting with reduced mobility (5.5%, n=20), acute confusion (2.7%, n=10) and polypharmacy (8.1%, n=29), all potentially modifiable frailty Conclusion The VIP tool is not sensitive to identifying the presence of pre-frailty markers including falls, polypharmacy and acute confusion. Further research is needed into the use of the VIP tool in Ireland. It is recommended that this tool is not used independently to identify frailty in the ED.