173 The development and early experience of a multidisciplinary acute in-patient frailty team

Abstract

Abstract Background Frail older adults represent a growing proportion of the acute in-patient population. A point-prevalence audit in our hospital revealed 40% of adult in-patients were frail (median age: 74). Following a patient-mapping exercise and review of service-user requirements, a consensus was reached among stakeholders that a multidisciplinary in-patient frailty team would be the most effective approach to supporting this group. The Rapid Assistance with Frailty Team (RAFT) work closely with Emergency Department (ED) and ward-based colleagues to optimise their care. Methods Newly admitted patients >75 years are screened daily for mild to moderate frailty (Rockwood Clinical Frailty Scale 5–6) and a Comprehensive Geriatric Assessment (CGA) is completed within 72 hours of admission. Hospital-associated complications e.g. deconditioning, delirium, weight loss, constipation, falls, cognitive and functional decline, are addressed through CGA-led recommendations. Physical and functional status are optimised through supplementary ward-based therapy and Geriatric Medicine support, with a view to facilitating earlier discharge. Results 609 CGAs were completed over a one-year period. Patients were primarily identified through daily screening (77.51%). Other referral sources included the ED Therapy Team, Primary Teams, therapies and nurses. In 50% of patients reviewed, new onset of confusion, decline in memory, or delirium was noted, with only half of those having a prior history of cognitive impairment. 80% presented with a decline in general function and approximately 35% were admitted with a fall as their main presentation. Polypharmacy was identified in 80% of this patient population. Conclusion The initial steps in implementing an inpatient frailty service, i.e. developing a system of patient identification, documentation to support CGA, and an integrated approach to working in a busy clinical environment, have been achieved. The focus is now on prospective data collection, continuous monitoring of key performance indicators, and feedback from service-users and staff, to further streamline this approach.