The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

[摘要] National guidelines mandate identification and tailoredmanagement of patients living with frailty who attendthe acute hospital setting. We describe using qualityimprovement (QI) techniques to embed a system thatallowed identification of frailty in older patients attendingthe emergency department (ED), creation of a clinicalpathway to facilitate comprehensive geriatric assessmentand appropriate same-day discharge of suitable patients.Integration of Clinical Frailty Scale (CFS) scoring withinan electronic record system, a continuing programme ofeducation and awareness, and dedicated project staffallows patients to be identified for an ambulatory frailtypathway. Our results show a sustained improvement over9 months of the project, with 73% of patients over the ageof 75 years presenting to ED by ambulance now receivinga CFS score. Over 300 patients have been identified,transferred to ambulatory care and treated via a newfrailty pathway, with an admission rate for this cohort of14%, compared with an overall admission rate of 50% forpatients over 75 years. We report a decrease in overall EDadmission of 1%. Analysis of patients discharged throughthis same-day pathway showed a 7-day ED reattendancerate of 15.1% and a 30-day readmission rate of 18.9%,which are comparable with current pathways. Consultantreview estimated 87% of patients to have avoided alonger admission. Patient and staff satisfaction indicatesthis pathway to be feasible and acceptable to users. Ourdata suggest an ambulatory frailty pathway can deliversignificant admission avoidance while maintaining lowreadmission rates. Similar schemes in other hospitalsshould consider using QI approaches to implementation offrailty pathways.

[学科分类] 药学