Formation of a Frailty Assessment Unit - From Pilot to Reality

Background

According to Healthcare Improvement Scotland, all hospitals should have an established frailty assessment area with access to a specialist frailty team within 4 hours of admission (or within 12 hours when out of hours). Timely CGA on admission is linked to improved patient outcomes. Last year at University Hospital Wishaw (UHW), a Rapid Access Frailty team (RAFT) with dedicated frailty beds was introduced over a 10-day period. They found an improvement with length of admission and discharge rates as well as positive feedback from staff. Following this pilot, a new Frailty Assessment Unit (FAU) has now been established at UHW.

Methods

There are four Medicine of the Older Adult (MOA) wards of which one was converted to the new FAU. new staff roles were created or re-allocated to the unit. There was a soft launch two weeks before the official opening. Board Rounds occurred twice daily with Doctors, Nurses, Allied Healthcare Professionals and Social Workers. Additionally, they provided CGA to patients. Criteria for admission were created and a frailty outreach team – formed of nurse specialists – was formed to support patients suitable for the FAU but were not in the unit.

Results

Average length of stay on the ward prior to the FAU was 12.3 days. This reduced to 7.4 days when the new unit opened. Across the MOA department, the average number of discharges increased from 37.5 patients a week to 40.3 patients with the percentage being discharged from the FAU going from 29% to 41%. Additionally, weekend discharges increased.

Conclusions

• Patients with frailty should have access to a specialist frailty team and assessment area
• A pilot RAFT at UHW last year demonstrated positive outcomes
• Establishment of a FAU has reduced length of stay and increased number of discharges