Abstract
Introduction Early access to specialist care is recognised to be beneficial for older adults living with frailty. Decision-making around assessing function and mobility to facilitate safe discharge can be challenging for staff in an Emergency Department environment. This can result in patients being admitted to await specialist review. The aim of this test of change was to explore the role and contribution of a Specialist Frailty Allied Health Professional (AHP) within the ED and to evaluate the impact on the care of patients living with frailty.
Methods For a 12-month period, the ED has had a dedicated frailty AHP to support staff in assessment. The role was adapted based on the needs of the clinical service. The impact of this intervention was evaluated using system-level performance data including frailty ascertainment; length of stay and discharge from ED. Staff feedback and patient journeys were collected to supplement quantitative insights.
Results There has been a 257% increase in patients being assessed by an AHP in ED (implementing early Comprehensive Geriatric Assessment (CGA)) and a 247% increase in number of patients discharged directly from the ED. In the first five months, there was a significant increase in referrals to appropriate community services, to support patients after discharge home, equivalent to 84-196 bed days. For those who are admitted, their CGA has already commenced and goals established. Staff feedback has shown an increase in confidence of supporting these patients, and greater awareness of both frailty and the services available to support patients after discharge from ED, rather than defaulting to admission.
Conclusions Having timely access to a dedicated frailty AHP is critical in effective decision making and improving patient outcomes. The Frailty AHP is a well-integrated member of the ED team and wider backdoor services. This has benefitted patients who are admitted and discharged