060Frailty in the Acute Hospital Setting: an Analysis of Patient Data

Abstract

Background: Our Care of the Elderly (COE) Department consists of 78 beds within the acute hospital. The current patient journey model is for admission to the Medical Assessment Unit (MAU) from the Emergency Department (ED) prior to triaging to the relevant medical specialty. As part of a review into the case for (or against) an Acute Frailty Unit we reviewed the characteristics of our current patient cohort. Methods: Data for patients admitted to one of our acute COE wards was contemporaneously entered into an anonymised database cataloguing information including frailty, length of stay (LOS) and rates of dementia and delirium. Frailty was defined by the use of a frailty screening tool which was agreed by the clinicians within the COE department. Results: Data for 423 patients was analysed. Mean age of patient was 83 years. 78.2% were identified as frail. A large number of patients came directly from ED rather than through MAU (70.8%). The LOS for frail patients was longer than non frail (mean 12.3 vs 8 days). The mean LOS for those frail patients admitted directly from ED was shorter than those frail patients who came indirectly to the ward (11.1 vs 14.8 days). The same trend was seen in the non frail (6.7 vs 15.2 days). 56.4% of patients were identified as having delirium. 43% of patients had a diagnosis of dementia. Conclusions: Whilst currently not designated as an Acute Frailty Unit we are already caring for a large number of frail older patients. Notably the LOS for both frail and non frail was shorter when patients were admitted directly to our department. This may be because the sickest patients would be prioritised for a MAU bed with telemetry (which our unit cannot provide), or early Comprehensive Geriatric Assessment decreases LOS.