Abstract
Introduction
“Getting it Right First Time – Geriatric Medicine” recommends the Clinical Frailty Scale (CFS) should be completed in patients aged 75+ on arrival in the Emergency Department (ED). Frailty services should focus on patients with a score of 5 or 6. The CFS has been shown to be easily completed in ED, however completion was variable.
Methods
A Frailty Intervention Team (FIT) based in ED was developed at the Royal Lancaster Infirmary. Around the same time the CFS was embedded into the trust’s electronic Manchester Triage Tool (MTT-CFS) within the Electronic Patient Record, along with a separate CFS Clinical Data Capture form for the frailty team to complete (FIT-CFS). Initially FIT reviewed the notes of all patients 75+, irrespective of MTT-CFS, to identify those suitable for assessment. A FIT Advanced Care Practitioner developed a training program for triage nurses focused on quality completion. FIT moved to a dedicated Same Day Emergency Care unit (FIT SDEC) and changed inclusion criteria to age 75+, MTT-CFS 4+.
Results
Completion of MMT-CFS was assessed, with 35.64 patients aged 75+ attending a day, with 32.41 forms completed ( 11.21 scoring 1-3, 21.2 scoring 4+). Comparisons were carried out between MTT-CFS and FIT-CFS, showing that the MTT-CFS scored significantly lower than FIT-CFS (p<0.01) but MMT-CFS of 4+ scored comparably to FIT-CFS 5+ (p=0.2465) Following the move to FIT-SDEC, 38.06 patients aged 75+ attended ED daily, with 36.51 MMT-CFS completed, 8.97 scoring 1-3, 27.57 scoring 4+ (non significant trend for improvement compared to pre FIT-SDEC).
Conclusion
Education and embedding the CFS in the MTT led to good compliance in completion however accuracy was poor. A pragmatic approach was to use the MMT-CFS 4+ to identify FIT-CFS 5+. Changing the pathway to include the MMT-CFS of 4+ showed a non-significant trend for improved compliance