Building a Frailty SDEC - The Journey

Introduction

The Queen Elizabeth Hospital (QEH), King’s Lynn serves a population of around 331,000 people. There has been exponential growth in the percentage of the population who are aged 65+.

The RCP recognises that older people with complex needs would benefit from prompt review by specialist geriatric teams, and the BGS recommends that there is a role for a dedicated geriatrician embedded within assessment units focusing on frail older people.

We implemented a number of pilot studies between 2021-2024, however, none provided sustainable excellent care models for frail patients. As such, the creation of a frailty SDEC (FSDEC) was agreed and began a trial in September 2024.

Method

The aim of the FSDEC Unit is to allow for the early identification and assessment of frail patients, avoiding admission where possible and promoting rapid discharge. By ensuring a multidisciplinary approach, frail patients are provided with the specialised knowledge, care and services required to ensure a safe discharge. The frailty team continue to provide an in-reach service into ED to ensure those patients that are frail but unsuitable for care in an SDEC environment also receive early CGA.

FSDEC is now fully established and staffed by a full MDT extending to our dementia support workers and volunteers.

Referrals are largely from the Emergency Department (ED) and directly from paramedics via our well-established frailty advice line. GPs, community matrons and community therapists are also frequent referrers.

Results

>5000 patients have been seen in FSDEC in just over a year with more than 80% being discharged the same day. Median length of stay in FSDEC is <18 hours and for those requiring admission, 5-7 days (compared to 10-13 days for patients with a Clinical Frailty Score >5 admitted without seeing FSDEC first). Over 25% of referrals to FSDEC come directly from paramedics on scene with frail patients, thus avoiding lengthy ED waits. Readmission rates are 17% (compared with a national expected average of 20-25% for frail older people).

Conclusion

The service has been recognised locally as of huge importance and our model shared with neighbouring Trusts. The MDT approach has been pivotal in the successes thus far. Seven-day working is the next step in the FSDEC development programme.