288 Do Frailty Assessments Improve Outcomes for Emergency Laparotomy Patients? A Quality Improvement Project

Abstract

Abstract Aim Our aim of the project is to increase completion rates of frailty assessments in emergency laparotomies to improve patient outcomes. Method This QI project focused on completion of the Rockwood Clinical Frailty Score (RCFS), Comprehensive Geriatric Assessment (CGA), Abbreviated Mental Test Score (AMTS), memory screening, place of residence and care level in patients over 65 years undergoing emergency laparotomies. Criteria was generated using British Geriatric Society recommendations and local hospital guidance. A year was sampled pre-intervention with the criteria, time clerked and grade. Data was assessed for admission and mortality statistics, and re-admission rates. A presentation to surgical juniors relating to frailty, frailty assessments and guidelines was used as an intervention. The data was re-sampled to identify changes post-intervention. Results Fifty-four laparotomy patients were sampled. 28% had a completed RCFS, 15% had a CGA, 67% had a place of residence, 41% had level of care documented, 13% had a memory screen and 7% had an AMTS. The small sample size restricted data analysis, however, there was a general decrease in length of admission and time to medically fit with increased frailty score completion. Post-intervention, completion of the RCFS, CGA, place of residence and care level increased. Completion of memory screening and AMTS decreased. Compliance increased in FY1s, SHOs and registrars. Conclusions The intervention had a positive impact: the average number of frailty criteria completed per patient increased by 39%, Foundation Year trainees now have frailty teaching, and the clerking booklet was reviewed. A re-audit is planned to ensure ongoing improvement.