160 Frailty at the front door: a two-way street

Abstract

Abstract Background The National Clinical Programme for Older Adults (NCPOP) advocates for timely access to integrated care that is attuned to the complex needs of older adults. Frailty Intervention teams have been introduced in Emergency Departments (ED) around the country, and have proven effectiveness in reducing wait times and hospital length of stay in older patients. The introduction of the Pathfinder service—a collaboration between acute hospitals and the National Ambulance Service—is also proving effective in reducing ED attendances for low-acuity problems in older adults. Methods We aimed to develop pathways between a Gerontological Emergency Department Intervention (GEDI) team, and a new Pathfinder team within our hospital catchment area, in order to support older adults to remain at home where safe and feasible. A mapping exercise of potential pathways between these services was conducted. Suitability criteria were developed and a communication strategy for case discussion was formulated. A collaborative approach was taken to ensure continuous two-way communication, and a patient-focussed ethos maintained throughout. Results A total of four open-ended pathways were identified between the two services: (1) Pathfinder convey patient to ED via GEDI team, and patient discharged from ED back to Pathfinder for follow up; (2) GEDI identify patient suitable for ED discharge, supported by Pathfinder team; (3) Patients discharged outside of GEDI operational hours (08:00–18:30) supported by Pathfinder team (where already assessed by GEDI); (4) Patients conveyed by Pathfinder, identified as suitable for Age-Related ANP-led Assessment Unit. Conclusion Close collaboration between two frailty-focussed older persons’ teams has helped to avoid unnecessary hospital admissions among frail older adults, and provide more gerontologically-attuned care on the acute floor. Through this close collaboration, we are reflecting the NCPOP aims of using integration and Comprehensive Geriatric Assessment to support older people to live well in their own homes.