164Finding the Frail in the Emergency Department - A Retrospective Review

Abstract

Background: The clinical syndrome of frailty is one of the most challenging consequences of the ageing population (Clegg et al, 2013). A frail older person will often present to the emergency department (ED) with nonspecific complaints. The BGS (2012) recommended that on presentation to the ED that screening for frailty should be completed with a more detailed assessment initiated if components of frailty are identified. Methods: A retrospective review of patient case notes of patients assessed in the ED of a large teaching hospital by the Frail Intervention Therapy Team (FITT) was completed. Cases were randomly selected from a FITT database between September 2015 and July 2016. Patients were assessed using the 'Think Frail' tool. Results: Approximately 4,500 patients were screened by FITT during this time period, 224 charts were reviewed. The average age was 84 years (+/-5.5 s.d.) and 63% were female. Three out of four patients presented with a functional impairment or immobility, while 38% presented with acute or chronic confusion. 38% of patients reported a fall at presentation, 59% had a history of falls in the last year. The highest rate of Health and Social Care (HSCP) referrals was for Physiotherapy (75%) and Occupational Therapy (61%), with 75% of patients requiring between one and four HSCP referrals. The main concerns identified by FITT were functional status (47%), cognition (22%) and/or social environment (10%). No concerns were identified for only one in three patients (35%). Conclusions: The implementation of FITT in Beaumont Hospital's ED has enabled earlier identification of frail older people, their impairments and has resulted in earlier HSCP referrals. This is the initial step in the development of a modern, whole system pathway for frail older people to ensure that patients are managed assertively and their length of stay is kept to a minimum.