31IMPROVING ACCESS TO COMPREHENSIVE GERIATRIC ASSESSMENT AT THE FRONT DOOR THROUGH A NEW AMBULATORY FRAILTY PATHWAY - AN INTERDISCIPLINARY QUALITY IMPROVEMENT PROJECT

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

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Front door to post-take: an interdepartmental quality improvement project to enhance patient journeys from emergency department triage through to the medical post-take review

Future Healthcare Journal ◽

10.7861/fhj.7.1.s23 ◽

2020 ◽

Vol 7 (Suppl 1) ◽

pp. s23-s23

Author(s):

Darryl E Bernstein ◽

Dana Li ◽

Abhishek Sharma ◽

Ajitha Jayaratnam

Keyword(s):

Emergency Department ◽

Quality Improvement ◽

Quality Improvement Project ◽

Improvement Project ◽

Front Door ◽

Emergency Department Triage

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Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

Journal of Nephrology ◽

10.1007/s40620-020-00878-y ◽

2020 ◽

Cited By ~ 1

Author(s):

Andrew C. Nixon ◽

Julie Brown ◽

Ailsa Brotherton ◽

Mark Harrison ◽

Judith Todd ◽

...

Keyword(s):

Quality Improvement ◽

Geriatric Assessment ◽

Screening Programme ◽

Management Plan ◽

Hazard Ratio ◽

Adverse Outcomes ◽

Quality Improvement Project ◽

Clinical Frailty Scale ◽

Improvement Project ◽

Management Plans

Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

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AGE – Structured Geriatric Assessment: A Quality Improvement Project in the Internal Medicine Service

Medicina Interna ◽

10.24950/rspmi/o162/16/2017 ◽

2017 ◽

Vol 24 (4) ◽

Author(s):

Raquel Ramos ◽

Keyword(s):

Internal Medicine ◽

Quality Improvement ◽

Geriatric Assessment ◽

Quality Improvement Project ◽

Improvement Project ◽

Medicine Service ◽

Age Structured

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The Whittington Frailty Pathway: improving access to comprehensive geriatric assessment: an interdisciplinary quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2019-000798 ◽

2019 ◽

Vol 8 (4) ◽

pp. e000798 ◽

Cited By ~ 1

Author(s):

John McGrath ◽

Paula Almeida ◽

Ruth Law

Keyword(s):

Quality Improvement ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Hospital Setting ◽

Admission Rate ◽

National Guidelines ◽

Clinical Frailty Scale ◽

Record System ◽

Improvement Project ◽

Same Day Discharge

National guidelines mandate identification and tailored management of patients living with frailty who attend the acute hospital setting. We describe using quality improvement (QI) techniques to embed a system that allowed identification of frailty in older patients attending the emergency department (ED), creation of a clinical pathway to facilitate comprehensive geriatric assessment and appropriate same-day discharge of suitable patients. Integration of Clinical Frailty Scale (CFS) scoring within an electronic record system, a continuing programme of education and awareness, and dedicated project staff allows patients to be identified for an ambulatory frailty pathway. Our results show a sustained improvement over 9 months of the project, with 73% of patients over the age of 75 years presenting to ED by ambulance now receiving a CFS score. Over 300 patients have been identified, transferred to ambulatory care and treated via a new frailty pathway, with an admission rate for this cohort of 14%, compared with an overall admission rate of 50% for patients over 75 years. We report a decrease in overall ED admission of 1%. Analysis of patients discharged through this same-day pathway showed a 7-day ED reattendance rate of 15.1% and a 30-day readmission rate of 18.9%, which are comparable with current pathways. Consultant review estimated 87% of patients to have avoided a longer admission. Patient and staff satisfaction indicates this pathway to be feasible and acceptable to users. Our data suggest an ambulatory frailty pathway can deliver significant admission avoidance while maintaining low readmission rates. Similar schemes in other hospitals should consider using QI approaches to implementation of frailty pathways.

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