279Outcomes in Older People with Frailty

Abstract

Background: In our hospital in 2016, patients aged over 75 accounted for 10.5% of emergency attendances, 18.5% of admissions and 43.3% of bed days. A Value Stream Analysis in October 2016 of patients with a length of stay > 14 days recommended a Specialist Geriatric Service on the acute floor. GEMS (Geriatric EMergency Service) aim is to improve the care, outcomes and patient experience of all older people with frailty attending our hospital. Methods: All emergency attendances aged > 75 years are screened on triage using the VIP tool. This screening is done electronically and is mandatory. Once identified on triage (VIP > 1) as at risk of adverse outcomes the patients are assessed early by any member of the interdisciplinary GEMS Team. A problem list, plan and Clinical Frailty Score are completed at the end of the CGA. Onward referrals are generated on completion of CGA and standardized work practices have been agreed by the GEMS and wider multidisciplinary teams. Data on case mix, service process and outcomes are prospectively collected on an Excel spreadsheet and we present analysis from 21/02/2017 to 20/02/2018 (365 days). Results: Each patient is scored using Rockwood's Clinical Frailty Scale (CFS) from range 1 to 9. (CFS, 1-very fit, 9-terminally ill). 32% were screened as Severely Frail, 28% -Moderately frail, 16% Mildly Frail. Only 7% of screened patients had new transfers to LTC and there were 6% in-hospital mortality. We then correlated our outcome results to CFS scores. Conclusion: Older people have tendency to be more frail. Patients with higher CFS score have longer lengths of stay, are more likely to be discharged to Long Term Care and have higher re-admission rates. We suggest that early CGA intervention on acute floor is critical in order to prevent adverse outcomes in older patients with frailty.