57ARE JUNIOR DOCTORS ABLE AND CONFIDENT IN ASSESSING FRAILTY?

Abstract

Introduction: Thirty percent of patients admitted to Acute Medical Units are elderly patients with frailty (NHS Improvement, IG 23/18, 2018). Frailty is associated with increased mortality (Fried, The Journals of Gerontology, 2001, 56, 145‐57). NHS England has mandated that by March 2019 frailty is assessed acutely in all patients over 65 years and that 75% of Type 1 Emergency Departments have an acute Frailty service (NHS Improvement, IG 23/18, 2018). Manchester Royal Infirmary (MRI), a large University Hospital, is currently working with the Acute Frailty Network to set up a frailty service. For this to be successful we need junior doctors to be able to correctly identify frailty. Methods: We aimed to assess whether Junior Doctors working within MRI have adequate knowledge subjectively and objectively about frailty and frailty scores, as well as their current clinical practice in these areas. We anonymously surveyed 56 randomly selected doctors across training grades. We then piloted a teaching session to assess if education as an intervention improved confidence and knowledge. Results: Of 56 Junior Doctors, only 27% stated they felt comfortable assessing frailty, despite the majority (89%) stating it was important. Eighty four percent felt they needed more training to adequately assess frailty. Only 36% of doctors said they routinely screened for frailty on admission. When assessing frailty 45% could select the frailty score used within the trust and 16% could detail how it was correctly used. Of those who felt comfortable assessing frailty, only 20% were using the frailty score correctly. After our pilot education session 100% in attendance understood the trusts frailty screening process and felt more confident in being able to perform the assessment. Conclusions: If frailty scores are used to provide triaging for frailty services we need to ensure that those involved have adequate knowledge. At MRI Junior Doctors have gaps in knowledge about frailty and our screening process. Most are consciously aware of this knowledge gap, however others are not and using screening tools incorrectly. We have capitalised on the request for more training highlighted by this project and the success of our initial pilot session, by providing teaching sessions to promote engagement in our service development process and ensure consistency in care.