CGA: Improving communication at discharge

Introduction:

The most recent national frailty benchmarking audit showed that many discharge letters from our Frailty Ward did not document a clinical frailty score (CFS), advanced care planning (ACP) or functional status.  

This project aimed to improve documentation of the comprehensive geriatric assessment (CGA) for patients seen by the Frailty Intervention Team (FIT) in Craigavon Area Hospital.

Methods

A baseline audit of 20 discharge letters from the FIT team was performed, assessing whether core aspects of the CGA were documented. Aspects of the CGA included were: CFS, ACP, cognitive issues, bone protection, anticholinergic burden score, mobility, skin integrity, nutritional status, swallow issues, issues with incontinence/ toileting, and assistance with activities of daily living.

Following the baseline audit, a standardised post take ward round template was designed. 20 discharge letters were audited again after introduction of this template.

Following this repeat audit, a standardised discharge letter was designed and implemented. A further 20 discharge letters were then audited.

Results

Implementation of a standardised post take ward round template improved documentation of the resuscitation status of patients from 55% to 65% of discharge letters but otherwise had minimal impact.

The standardised discharge letter template had a significant impact. Documentation of resuscitation status improved from 55% to 85%, documentation of CFS improved from 65% to 80%. Documentation of mobility  improved from 25% to 60%. Documentation of anticholinergic burden scores improved from 5% to 60%. Documentation of whether cognition was addressed improved from 30% to 85%.

Conclusions

This project has improved the documentation of the CGA undertaken by the FIT team in Craigavon Area Hospital. This should in turn help communication between secondary and primary care, and help ensure vital information around mobility, frailty and advanced care planning is easily available to admitting doctors for future hospital admissions and referrals.