1942 Developing a Frailty SDEC Team at Salford Care Organisation

Abstract

Abstract Introduction Frail older adults have longer waiting times in emergency departments (ED’s), are more likely to be admitted, and have longer lengths of stay1,2. The NHS Long Term Plan requires hospitals to provide an Acute Frailty Service (AFS) for at least 70 hours/week and complete a Clinical Frailty Score (CFS) within 30 minutes of arrival3. The plan advocates Same Day Emergency Care (SDEC) to reduce admission related harms and discharge patients in a timely way4. The introduction of an acute frailty CQUIN that requires prompt identification of frailty and initiation of CGA is another driver for the development of AFS5. Methods We created an acute frailty SDEC team including a frailty nurse, clinical-fellow, advanced clinical practitioners and GPs. The team was present in ED on weekdays between 9am-5pm with 1-2 team members on each shift. A Consultant Geriatrician provided advice and support. We developed loose frailty SDEC criteria: - Age >=65years with CFS>=5 and - NEWS<3 - Triage note suggests patient may not need hospital admission. Results Over a 4-month period, 262 patients were seen by the SDEC team. Age and CFS score for this population are shown in Graphs 1 and 2. Graph 1: Age of Patients Reviewed by SDEC Team Graph 2: CFS Score of Patients Reviewed by SDEC Team -74% were seen within 2 hours as demonstrated in Graph 3 Graph 3: Minutes patients waited to be seen (WTBS) from arrival at ED triage - 131(50%) of patients were discharged directly from ED. A further 25 patients were later discharged from EAU. Conclusions A frailty SDEC service results in early identification of frailty, timely assessment in ED and a high likelihood of discharge (60%) directly from ED or EAU rather than being admitted to an inpatient ward. Implementation of a 7-day service would only serve to increase these figures.