Abstract
Introduction Frailty is associated with delayed clinical assessment in ED, increased length of stay (LOS) and inpatient mortality. Frail older adults have complex medical and psychosocial problems, difficult to address in ED. In line with the NHS Long Term Plan, our fSDEC pilot aimed: to deliver early comprehensive geriatric assessments (CGA); manage acute presentations to avoid unnecessary admissions; reduce ED waits and reduce the LOS for those admitted. Methods The fSDEC pilot had an ACP, a trainee ACP and two resident doctors (SHO and registrar) with support from a consultant and access to a therapist, a pharmacist and urgent community response teams. Patients were triaged by fSDEC for suitability on weekdays 8am – 6pm. Ambulant patients were seen in pre-existing shared SDEC space; non-ambulant patients were managed in ED. All patients had a CGA within thirty minutes of arrival. Results In twelve months, 729 patients were seen and 81% discharged same-day. Table 1: Categories of presentation: Most common was fall 39%. Table 2: Number of patients seen each month and number of days fSDEC not run: average number of patients seen 3.5/day Without fSDEC it was estimated 80% of these patients would have been admitted. For example, patients who present with falls have an average LOS of 13 days. fSDEC saves 234 bed-days/month for falls, which amounts to £70,000/month. For total presentations this can be extrapolated to 620 bed days, saving £186,000/month. Conclusion With fSDEC there was higher likelihood of same-day discharge; improving flow, patient experience and offering financial savings. This was aided by engagement from stakeholders, access to community In-Reach CNS and flexibility of staff. In future, we aim to have a frailty friendly space and more consistent staffing. There was positive feedback from patients and the Trust (the team were finalists for 'All Star Team of the Year').