186Improving Outcomes in Older People with Frailty: A Prospective Study of the Geriatric Emergency Medicine Service (GEMS)

Abstract

Background: Ireland is currently facing the challenge of providing quality and costeffective health care for an increasing and ageing population. Older people with frailty are a complex cohort at high risk of adverse outcomes and high resource users. We developed a pathway in St. Luke's General Hospital (SLGH), Kilkenny, to optimise care and outcomes for older patients with frailty. Weighted estimate of frailty in our CHO area (5) is estimated at 22.9% (Tilda, wave 1). We launched our acute frailty service (GEMS) on 21st February 2017. The core team is based in AMAU and ED. All patients aged 75 and over who attend Acute Medical Assessment Unit (AMAU) and Emergency Department (ED) are screened on triage using a 3 question tool;'Variable Indicative of Placement risk' (VIP) and interdisciplinary Comprehensive Geriatric Assessment (CGA) is delivered within 72 hours to patients who are positively identified. Methods: Data is collected on an Excel spreadsheet and we present analysis from 21/2/2017 to 27/04/2017 (65 days). Results: 879 patients aged 75 and over attended during the time period. 41% were identified as at risk. Average age was 85.1 years. 67% received CGA and within 1.63 days. Admission conversion rate was 56%. The average length of stay was reduced from 10.6 to 8 days p < 0.01 (p < 0.05) 45% were identified as 'Vulnerable to Moderately Frail' (4-6) on Rockwood Clinical Frailty Score (CFS) and 31% as 'Severely frail to Terminally ill' (7-9). Conclusion: GEMS pathway reliably identifies older people at risk of adverse outcomes e.g. polypharmacy, malnutrition, falls etc. and reduces the average length of stay in hospital. Critical to the success of the service is the mandatory screening on triage and the interdisciplinary culture of the team. We hope to expand our service to include an ambulatory assessment unit and an in-patient acute frailty unit.