Abstract
Introduction
East Surrey Hospital (SASH) recognised in April 2024 that there was no acute frailty pathway or same day care service specifically for older people. It performed 3rd or 4th quartile for all performance indicators regarding the care of frail or older people. Older people occupied 60% of bed days at SASH and had the longest emergency department wait times.
Materials and Methods
SASH made a strategic commitment to improve outcomes for frail and older people. A best practice review and initial trajectory modelling led to trial of an acute frailty team. This resulted in a full business case with executive sign off. Implementation was based on lean quality improvement methodology (SaSH+) and through a series of PDSA cycles and gemba visits.
This led to the development of the current frailty service. This consists of an acute MDT frailty team, frailty same day emergency care, and short stay unit.
Results and discussion
Since start (October 2024) 476 patients treated in Same Day Emergency Care. 71% discharged on same day. Equivalence of 39 bed days saved over 12 months. Length of stay reduced by 3.4 days if seen by ‘Gemini’ team, with lowest average since COVID. 9/10 patients discharged to their own home if seen by ‘Gemini’ team compared to 6/10 previously. 37.5% increase in discharges within 3 days. Number of patients admitted from Emergency Department reduced by 13%. Whilst mortality and readmission rates have not increased.
Conclusion
The introduction of ‘Gemini’ frailty team has provided a huge benefit to vulnerable patients, providing admission avoidance without increased mortality or readmission. A trust commitment to frailty remains a priority, as this is shown to benefit patients and improves the trust position against national benchmarks.