Frailty-based care in hospital

Access to experts offering frailty-based care in hospital with frailty assessment, diagnostics and pathways.

What work

  • Implement a front door MDT to assess frailty, commence CGA with links to community teams and VSCE for robust discharge – 24/7
  • Implement strategies to avoid unexpected deaths – warning scores, critical care outreach, regular senior review and adequate access to high dependency beds.
  • Create safer care – prevention and treatment of falls, pressure sores, hospital-acquired infection, medication errors, deep vein thrombosis and malnutrition, delirium and immobility as a result of bed rest.
  • Minimise in-patient moves (especially in patients with delirium)
  • Offer frailty liaison and in-reach services
Benefits

  • Reduction in falls, medication errors, VTEs, and delirium
  • Reduced functional decline
  • Improved experience of care
  • Reductions in bed occupancy, readmissions and length of stay
  • Reduction in mortality without affecting re-admission rates or requiring additional resources.
  • Improved survival at home after discharge

Evidence summaries

Redesigning the system of care for older emergency patients led to reductions in bed occupancy and mortality without affecting re-admission rates or requiring additional resources – https://academic.oup.com/ageing/article/43/4/472/15318

Acute Geriatric Units have been shown to reduce the risk of functional decline and increase the probability of returning home; such units have not been compared directly to an Acute Medical Unit (AMU) in the UK – https://www.dc.nihr.ac.uk/themed-reviews/frailty-in-hospital-research.htm

Older Persons’ Assessment and Liaison (OPAL) teams have shown to improve outcomes in hospital for older people’s care.

Silver book – https://britishgeriatricssociety.wordpress.com/2012/06/21/the-silver-book-guidelines-for-the-emergency-care-of-older-people/

Embedding comprehensive geriatric assessment in the emergency assessment unit: the impact of the Comprehensive Older Person’s Evaluation (COPE) zone – More patients with

markers of frailty were discharged directly from EAU without increasing readmissions. Mean length of stay was reduce- https://www.rcpjournals.org/content/clinmedicine/16/1/19.full.pdf

NIHR Themed Review – Comprehensive care for older people living with frailty in hospitals – https://www.bgs.org.uk/resources/nihr-themed-review-comprehensive-care-for-older-people-living-with-frailty-in-hospitals

Impact and Measures

Work in progress

For more information to aid local delivery see what works, resource links, benefits, evidence, local stories and case studies as well as impact/measures in ‘word version of draft frailty toolkit’ page 75