Examining outcomes of bone health assessments in an acute frailty setting

Introduction

Previous quality improvement work in our acute frailty service has focused on improving rates of bone health assessments. Here we examine the outcomes of these assessments.

Method

Data on bone health assessments were collected retrospectively using electronic health records for patients admitted to Frailty Same Day Emergency Care unit (FSDEC; n=118) and Acute Senior Health Unit (ASHU; n=107) over 2 months. Data collected included whether patients had presented with a fall, had a bone health assessment completed, and the outcome of any assessment. 

Results

50% of patients seen in our services presented following a fall (57% FSDEC; 42% ASHU).

71% of these patients had a bone health assessment completed (60% FSDEC, 87% ASHU), an improvement in bone health assessments from previous audit cycles in this service.

The most common assessment tool was FRAX, which was used for 96% of patients (95% FSDEC, 97% ASHU). QFracture and BONE-PARK were also used.

For patients with a completed FRAX assessment (n=76), the outcomes for 36% were low risk ('Give Lifestyle Advice'), 34% were intermediate risk ('Measure bone mineral density') and 25% were high or very high risk ('Treat' +/- specialist referral).

Patients seen in FSDEC were more likely to be scored as high or very high risk (FSDEC 40%; ASHU 8%). 9% of patients did not have the outcome of their FRAX assessment documented.

Conclusion

Around half of patients seen in our acute frailty services presented following a fall. Most of these patients have bone health assessments completed, most commonly a FRAX score. Lower completion rate in FSDEC may be representative of the time-constraints and clinical priorities in same-day emergency care. Further work should 'close the gap' on improving bone health assessment rates and documenting outcomes, as well as looking at what actions are prompted by these assessments.