Abstract
Introduction The Commissioning for Quality and Innovation (CQUIN) framework sets a 10% minimum and an ideal goal of 30% of acutely presenting patients over the age of 65 to receive frailty assessment scores. Early recognition of frailty helps mitigate risks such as deconditioning. This project aims to assess and improve the adoption of this standard in medical emergency admissions of a Birmingham district general hospital by working with medical admissions teams and frailty services and observing for associated outcome measures. Methodology PDSA methodology was used. Data was retrospectively collected for patients aged 65 and above from the electronic patient records (EPR) over a week’s interval from the acute medical take. Collected data included prevalence of CFS scoring and social history, escalation discussions and mortality. Interventions were delivered via an educational presentation to resident doctors and displayed posters in key areas. The data was examined for improvements in CFS prevalence and its relationship with onwards referral, escalation discussions or mortality. Results Pre-intervention only 3.31% (8/242 patients) had a recorded CFS score . . Post-intervention, 19.10% (34/178) patients had a CFS score documented. Post-intervention, 82.35% of those with CFS scores were referred to the frailty therapy service, as opposed to 17.36% of those without CFS scoring. Escalation discussions were had with 41.17% of those with CFS scoring and 29.17% of patients without. Mortality was 5.88% in the CFS scored patients and 9.72% in the patients with no CFS score. Conclusion After focused interventions, the CFS prevalence was above the 10% minimum requirement and closer to the 30% goal set by the CQUIN 05. Patients with a CFS score saw higher rates of onwards referrals to older person services, and higher rates of escalation discussions . In forwards application, CFS could be discussed in induction, incorporated into IT clerking systems
Comments
Good work. CFS is of utmost…
Good work. CFS is of utmost importance. It will be helpful if it is made a mandatory parameter to complete the clerking for any patient above 65.
Great
Well done. Great to check CFS. It helps prognosticate and target intervention. It should be delivered as part of CGA but it is really useful too outside of this like on medical clerking or nurse triage as a prompt to oneself and later team members involved in patient care.
How good are colleagues at scoring? Do they agree? Do scores change as more information comes to light (or does lack of information hinder scoring at first assessment)?
reply to Ian Thompson
Thank you for your comment !
We did initially collate data on if the CFS scoring changed once the frailty service had seen the patient. However there were so few patients who had both a recorded CFS score in the clerking and a CFS score from the frailty service that there wasn't a good data pool to analyse. It would be interesting to look into this in the future.
You ask about level of information in the clerking and if that hinders scoring. In the poster, you can see that we collected data on if there was an adequate history of ADLs or mobility history. Some clerkings had detailed histories and others gave a narrower picture such as 'care home resident' or 'daily carers' without information on which tasks they needed help with. We counted a clerking as having adequate social or ADL history if a CFS could be worked out from the level of information recorded. We excluded patients who were referred to the medical team but where no history was taken (eg unconscious with no collateral available, or died in ED).
I hope this answers your query !
A great initiative
We have similar expanses the cohort of patients flagged with alert to record CFS in primary care
Proactive CFS recording through a broad age range helps to capture those who have premature deterioration of health and it is also really useful in identify those whose condition is changing
Interesting read, thanks. At…
Interesting read, thanks. At my trust CFA scoring has been introduced in the electronic clerking proforma with the pictogram of scores, which seems to have worked well.