110SERVICE DEVELOPMENT: TRIAL OF AN ACUTE FRAILTY ASSESSMENT AREA WITHIN THE EMERGENCY DEPARTMENT

Abstract

Topic: In 2016 there were 23.5 million attendances at Emergency Departments in England. One fifth of those were people aged 65 and older [1]. Our existing frailty pathway comprised an in-reach team in the emergency department (ED) and a frailty unit. Rising demand required us to establish the team in ED. Intervention: We initiated discussions with key stakeholders within the trust and presented a business case to procure use of an available space within ED. A working group was set up involving key managers and clinicians from Geriatrics, Acute medicine and ED. Here we outlined staffing requirements (2 nurses, 1 HCA, 2 ANP's, 1 Consultant Geriatrician, 1 StR and a physician's associate and therapy team), equipment needs, working hours and patient selection (frailty) criteria. The designated acute frailty area within our ED consisted of 6 cubicles where frail older patients could be assessed immediately by the frailty team direct from the initial assessment unit (IAU) in ED using pre-defined frailty criteria. Patients were assessed by the MDT before entering one of four pathways: Discharge, admission to frailty unit, admission to the acute geriatrics, direct admission to ward. Patient admission data (time to be seen, numbers discharged and admitted, length of stay in the frailty area and number of breaches) was collected weekly over 7 weeks. Patient and carer feedback was also collated. Improvement: 401 patients seen by the service - vastly increased from the previous model. 131 (41.07) of patients were discharged directly from ED. 14 returned to the emergency department in 7 days (3.1%). 69 returned with 28 days (17.0%) - below average to our speciality as a whole. Median length of time to be seen once admitted to frailty area from IAU 14 minutes. Usual interventions are CGA, medication review and physical and social review. Discussion: Challenges were procurement of the space against competitors, securing full buy from key stakeholders, secondment of staff, ensuring the right equipment in place and finally staff adaptation to a new pace/style of working. However, with daily PSDA cycles and process mapping the pilot has been a success in terms of metrics, patient experience and staff feedback.