934 IMPROVING THE QUALITY OF FRAILTY DISCHARGE SUMMARIES THROUGH INCORPORATION OF A COMPREHENSIVE GERIATRIC ASSESSMENT

Abstract

Abstract Introduction The CGA identifies patient needs within seven domains: cognition & mood, continence, mobility, speech and language therapy, skin integrity, social context, nutrition; has been shown to reduce admission and readmissions, and when combined with a personalised care plan, can reverse progression of frailty. We aimed to improve discharge documentation of the seven CGA domains on two elderly care wards at Southend University Hospital, within two months. At baseline, only 18% of all domains were addressed. 87% of observations were subjective, while personalised care plans addressing at risk domains were absent. Method Three outcomes measured included: 1. % of all domains addressed 2. % of domains with objective/measurable observations 3. % of discharge letters with personalised care plans addressing at least one domain PDSA 1 introduced CGA as a concept through teaching sessions to the frailty MDT. PDSA 2 presented a poster to provide measurable criteria for each domain. PDSA 3 created competition between wards, through light-hearted forfeit. PDSA 4 offered a checklist proforma. PDSA 5 introduced personalised care plans targeting ‘at risk’ domains. Results PDSA 1, 2 and 3 showed incremental improvement in all outcomes. % CGA domains addressed improved from 17% to 74%. % objective or measurable observations improved from 13% to 51%. % of letters with personalised care plans improved from 38% to 74%. PDSA 4 showed a decrease in all outcomes, although remaining above results at baseline. PDSA 5 revealed an improvement in all outcomes compared to PDSA 4. Conclusion Through regular interventions, including empowering the frailty MDT to value CGA, significant improvement can be achieved. Consistent teaching proved steady improvement in all outcomes, while introducing competition showed the greatest improvement. Further plans to introduce to other medical wards and to digitise the CGA pro-forma are in progress to ensure sustained improvement.