85IS THE MDT FIT FOR FRAILTY? EMBEDDING RECOGNITION OF FRAILTY INTO THE REGULAR PRACTICE OF MULTIDISCIPLINARY MEETINGS

Abstract

Background: Recognition of frailty across primary and secondary care is one of the biggest challenges for integrated patient-centred care. Under recognition of frailty is a significant problem. This quality improvement project aimed to: 1. Improve the recognition of frailty and 2. Improve the communication to primary care of those identified with frailty Method: Retrospective analysis of discharge summaries from the Elderly Care Unit (ECU) in April 2016 identifying patients coded for frailty. Intervention: The Multidisciplinary Team (MDT) were educated and asked to commence using the Clinical Frailty Scale (CFS) (Rockwood et al. CMAJ 2005;173:489-495) in ward Multidisciplinary Meetings (MDM). Doctors were asked to document frailty in those identified in the MDM on the problem list of the discharge summary. A feedback survey of the MDT and a prospective review of discharges from the ECU in April 2017 were performed. Results: (Table presented) The number of patients identified with frailty in the MDM improved from none to 22 between April 2016 and April 2017. All survey responders either agreed or strongly agreed that “ward MDMs are an appropriate time to assess for frailty”. The majority of responders (86%) either agreed or strongly agreed that “CFS was easy to use”. Conclusions: We have achieved an improvement in the recognition of frailty within the MDT, but there remains significant scope to improve. Anecdotally we know that more than the 22% of ECU patients identified are living with frailty. Embedding a lasting shift in practice to assess all ECU patients for frailty is the next challenge. Survey feedback suggests the MDM and CFS are the right tools to improve the recognition of frailty, the main barrier is embedding this in the MDM. Once identification of frailty improves we can focus on communication to primary care. The next steps are: Create a MDM proforma including a prompt for frailty assessments. Educate therapists, doctors and nurses in recognising frailty. Present findings to the department to increase motivation.