75FRAILTY IN A HAEMATOLOGICAL ONCOLOGY UNIT: THE INTRODUCTION OF FRAILTY SCREENING TO IMPROVE ACCESS TO THERAPEUTIC SERVICES FOR THE OLDER POPULATION

Abstract

Background: The incidence of haematological cancers is highest in those aged over 65 (NHS Scotland Information Services Division, 2015). Frailty is common in older people with medical illness (Health Improvement Scotland (HIS), 2014) but specialist cancer services are not well equipped to deal with the needs of complex, frail patients. Objective(s): The Haematology Older Persons' Project (HOPP) aimed to: enhance early, goal-orientated, multidisciplinary input to maintain or improve functional status and support early discharge planning & release time for MDT members to re-invest in specialist roles whilst also allowing data collection to: describe the characteristics of inpatients aged >=65 identify markers of frailty in these patients assess the relationship between frailty and length of stay (LOS)/readmission rates. Method(s): A Frailty Nurse Practitioner (FNP) and Therapy Assistant were employed full time, to assess all Haematology inpatients aged 65 or over using the HIS frailty screening tool (five parameters). Those with one or more frailty feature were reviewed by the FNP and had ongoing input from the Therapy Assistant, in addition to usual Physiotherapy and Occupation Therapy (OT) services. Access to and delivery of therapeutic services was measured before and during the project. LOS and readmission data were analysed using linear and logistic regression. Evaluation: To date, 583 patients have been screened; 62% male, aged 49-97 (mean 74, median 72). 80.5% were emergency admissions and were further analysed. 79% had >=1 frailty feature, 54% had >=2 frailty features. 8% died during admission. 83% were discharged home. Number of frailty features was associated with increased LOS (an extra 2.81 days (95%ci 1.82 to 3.1) per frailty feature), but there was no relationship with likelihood of readmission within 7 days. HOPP eliminated previous delays between referral and first OT assessment by providing screening on admission and, where necessary, prompt initiation of therapy. HOPP has increased access to therapeutic services, with an overall 69% increase in the number of therapy sessions delivered. Conclusion(s): Frailty is common amongst older Haematology inpatients and correlates with length of stay. Early identification of frail patients allows them to receive patientcentred MDT input to ensure optimum, efficient pathways of care.