Abstract
Introduction: Older people living with frailty are core users of health and social care. Services attuned to their needs afford better outcomes, help avoid harm and improve the experience for people living with frailty and their carers. These services may also help with flow and capacity. The Glasgow Royal Infirmary (GRI) Team aimed to advance services in order to enhance the quality and provision of care for older people with frailty.
Methods: As part of the Health Improvement Scotland Focus on Frailty Programme, the GRI Team developed processes for early identification of people living with frailty, using an electronic Frailty Assessment Tool. Processes were designed to streamline patients with frailty to specialist care in order to initiate early Comprehensive Geriatric Assessment (CGA). A Frailty Assessment Proforma was created to promptly identify the priorities, concerns and goals of patients and carers and to gather key collateral information swiftly. Daily CGA Huddles were commenced, which include participants from various acute and community health and social care services. Work is now being done to further develop the Acute Frailty Assessment Area. Rapid Access appointments at the Assessment and Rehabilitation Centres, to support early discharge, have been initiated.
Results: There has been an improvement in frailty identification. 74% patients 75 years and over, admitted through the Acute Medical Receiving Unit, are being screened for frailty. The proportion of patients with frailty in our Acute Frailty Assessment Area has increased. Collaborative and integrated working has been enhanced, particularly through the CGA Huddles. Length of stay for people with frailty has reduced by 3 days and this has not been coupled with an increase in readmissions at 7 and 30 days.
Conclusion: Frailty attuned acute services help patients receive person-centred, specialist care. Time in hospital can be reduced, which can contribute to improving flow and capacity.