31IMPROVING ACCESS TO COMPREHENSIVE GERIATRIC ASSESSMENT AT THE FRONT DOOR THROUGH A NEW AMBULATORY FRAILTY PATHWAY - AN INTERDISCIPLINARY QUALITY IMPROVEMENT PROJECT

Abstract

Introduction: At Whittington Health we have embarked on an interdisciplinary quality improvement (QI) project to better integrate care of older people moving through the Emergency Department (ED) and increase their access to comprehensive geriatric assessment (CGA). Method: Over the last 8 weeks, through the use of cross-departmental and interdisciplinary QI meetings and using a 'PDSA' approach we have embedded the use of Rockwood Clinical Frailty Scale into our electronic triage for patients who are aged 75 and over and created a new ambulatory frailty pathway for patients scoring 5 or more. These patients are moved from ED to our nationally renowned ambulatory care department for more timely CGA. A safer discharge is facilitated with the help of our virtual ward and CGA is completed in the community by our community geriatrics service. The patients' goals remain central throughout the assessment process. All members of the multidisciplinary team have contributed equally to pathway design, data collection and weekly PDSA meetings. Results: By week 8 of the project, from a starting point of zero, 44% of patients over the age of 75 presenting to ED by ambulance now receive a Rockwood Score. This continues to improve weekly. So far 70 patients have been treated via the pathway. Admission rate for this cohort has dropped from 50% to 16% with no increase in reattendance or 30 day readmission. Patient and staff experience data is currently being collected but feedback to date is overwhelmingly positive. Conclusion: The rapidity and success of this pathway redesign is a testament to the value of interdisciplinary working not only with our patients but in quality improvement cycles. Each team member brings a unique perspective on how the change will affect every day working and how best to overcome organisational hurdles. Using this approach we have avoided silo-working and made a large impact very quickly. We are all energised by the improvement we have been able to make in access to CGA, away from the busy ED environment and the benefit this has brought to patients in allowing them to spend more days at home.