5FRAILTY ASSESSMENT IN PATIENTS UNDERGOING CARDIOVASCULAR INTERVENTIONS: A QUALITY IMPROVEMENT PROJECT

Abstract

Topic: With an ageing population, more elderly patients are undergoing elective surgery. Frailty is an ageing-associated independent risk factor for post-operative morbidity and mortality. It is important to recognise frailty to identify the vulnerable patients, avoid unnecessary harm and improve outcomes. The British Geriatrics Society recommends that patients should be assessed for frailty prior to surgical interventions. In this quality improvement project (QIP), we looked at whether the Rockwood Frailty Score (RFS) was appropriately used in the pre-operative assessment of cardiac patients. Intervention(s): All patients have an electronic pro-forma which includes a section on the RFS completed, prior to discussion at the multi-disciplinary meeting (MDM). The pro-formas were reviewed to determine if a) the RFS was calculated and b) the calculated score was accurate. This was done by comparing the calculated score against the score allocated by ourselves from reviewing electronic patient records. In the first cycle, we reviewed 46 patients between October-November 2017. Of these, 6 had a frailty score done but only 1 was correctly calculated. We then implemented a change, which involved a consultant geriatrician educating team members on frailty assessment and completion of the RFS. Improvement: We re-evaluated the scores between November-January 2018, identifying 44 patients. 33 had a score calculated; an improvement from 13% to 75%. The RFS was done correctly for 15 patients; an improvement from 17% to 45%. In both cycles, we noted a frequent underestimation of the scores with the frequency being greater towards the lower end (1-2) than the higher end (5-6). Discussion(s): This QIP demonstrated that frailty scores are not adequately completed in pre-operative patients. Following our intervention, there was a significant improvement in the completion rate and some improvement in the accuracy. Frailty assessment is particularly important in procedure dominant specialties such as cardiology and cardiothoracics due to the potential for adverse outcomes such as delirium, decreased function and death. This can be reinforced with further education. However, it can be challenging to fully evaluate the severity of frailty as cardiologists or surgeons. Once frailty is recognised, a comprehensive geriatric assessment is required. This highlights a need for having liaison geriatricians in cardiac MDMs. The importance of frailty assessment is being increasingly recognised but we still have a long way to go.