Abstract
BackgroundThe incorporation of acute frailty services into the acute care pathway is increasingly common. The prevalence and impact of acute frailty services in the UK are currently unclear.MethodsThe Society for Acute Medicine Benchmarking Audit (SAMBA) is a day of care survey undertaken annually within the UK. SAMBA 2019 (SAMBA19) took place on Thursday 27th June 2019. A questionnaire was used to collect hospital and patient-level data on the structure and organisation of acute care delivery. SAMBA19 sought to establish the frequency of frailty assessment tool use and describe acute frailty services nationally. Hospitals were classified based on the presence of acute frailty services and metrics of performance compared.ResultsA total of 3218 patients aged ≥70 admitted to 129 hospitals were recorded in SAMBA19. The use of frailty assessment tools was reported in 80 (62.0%) hospitals. The proportion of patients assessed for the presence of frailty in individual hospitals ranged from 2.2 to 100%. Bedded Acute Frailty Units were reported in 65 (50.3%) hospitals. There was significant variation in admission rates between hospitals. This was not explained by the presence of a frailty screening policy or presence of a dedicated frailty unit.ConclusionTwo fifths of participating UK hospitals did not have a routine frailty screening policy: where this existed, rates of assessment for frailty were variable and most at-risk patients were not assessed. Responses to positive results were poorly defined. The provision of acute frailty services is variable throughout the UK. Improvement is needed for the aspirations of national policy to be fully realised.
Highlights
The incorporation of acute frailty services into the acute care pathway is increasingly common
We aimed to describe the extent to which frailty identification is undertaken within a cross-section of UK hospitals and describe variations in the structures and processes employed
The proportion of patients discharged on the same day as admission is reported from a sub-group of patients with a National Early Warning Score 2 (NEWS2) less than five as crude adjustment for severity of acute illness
Summary
The incorporation of acute frailty services into the acute care pathway is increasingly common. The acute care system assesses and treats an increasing number of older patients with complex health needs. The concept of frailty has become central to the understanding of acute illness in older people [4]. The NHS Long Term Plan states that all hospitals with a 24 h Emergency Department (ED) will provide an acute frailty service for at least 70 h a week, with the aim to complete a clinical frailty assessment within 30 min of a patients arrival in the ED or SDEC (Same Day Emergency Care) unit [14]. The policy is designed to reduce unnecessary hospital admissions and reduce the length of stay by providing interventions, such as comprehensive geriatric assessment (CGA) at earlier time-points within the acute care pathway
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