Abstract
Introduction
We were wanting to better understand the population of older people accessing a district hospital emergency department, to identify how a front door frailty team could be utilized and estimate the potential impact this could have for the hospital.
Method
All patients over the age of 65 who were within the Emergency department on 4 consecutive Thursdays between 8am and 4pm were assessed and proposed a potential intervention from a front door frailty team (either to be streamed to an SDEC or community service, receive a review in ED, ward follow up, or no intervention at all). All patients’ notes were then followed up including ED disposal, inpatient notes if admitted, length of stay and their 7 and 30 day outcomes.
Results
Of the 121 patients I was able to review and follow up, I believed 48 would have benefitted from intervention from a dedicated frailty team. Of these 48 patients, 28 were admitted to the hospital and totaled 161 bed days. On review of the notes many patients were deemed to be medically fir for a number of days prior to discharge (61 in total), which we know has a huge impact on a patients’ welfare, risk of hospital acquired harms as well as the impact on patient flow and hospital resources. Unfortunately, one patient deemed medically fit was unable to have an essential D2A to facilitate discharge, and he deteriorated and subsequently died in hospital. His preferred place of death was his own home. Conclusions I believe every emergency department would benefit from a dedicated front door frailty service, which would not only serve to improve patient care and allow a comprehensive geriatric assessment, but also serve the hospital to improve flow, reduce admissions and the associated complex discharges from hospital wards back to community care.