229Home FIRsT - Outcomes of a Frailty Intervention and Response Team in the Emergency Department of a Large Acute Teaching Hospital

Abstract

Background: Emergency Department (ED) attendance, for an older person is often associated with elevated risks of deleterious outcomes due to a reduction in physiological reserves. A holistic model of care, delivered by interdisciplinary teams embedding geriatric competencies into their service has been recommended (Conroy & Turpin, 2016). Home FIRsT (Frailty Intervention & Response Team), comprising a candidate Advanced Nurse Practitioner, Clinical Specialist Occupational Therapist, Clinical Specialist Physiotherapist and Medical Social Worker was introduced to the ED of large acute hospital in May 2017. Objectives include avoidance of unnecessary admissions among older patients (>70 years, Manchester triage category 3-5). Methods: Quality Improvement methodology underpinned the development of care pathways. Tests of change were performed using Plan-Do-Study-Act cycles. The team developed a common assessment form using shared interdisciplinary competencies. Patient demographics and outcomes are collected for the purposes of prospective auditing; Microsoft excel is used for data collection and analysis. Results: In the first nine months of service delivery, 1980 ED attendances were recorded. 802 were male (41%) and 1,178 female (59%) with a mean age of 80 years (range 63-104). 60% (n = 1,203) were discharged home from the ED; 21% (n = 257) had onward referral to Medicine for Older Persons ambulatory care services. Compared to the same nine month period the previous year there were approximately 230 fewer admissions among similar patients corresponding to a bed day saving of 4,500 days. In relation to ED re-attendances, 10% of those discharged had an unscheduled admission within a month (hospital re-admission rate for similar patients was 13% over the same period). Conclusion: Home FIRsT enabled comprehensive geriatric assessment to begin in the ED and prevented approximately 1 admission a day without raising re-admissions. The bed day saving equates to about ∈4.5 million, which highlights the efficacy and cost effectiveness of this service.