Frailty ACP led discharge within the Emergency Department: A pilot study

Introduction

Prolonged periods in the emergency department carry risk for people living with frailty. Early frailty assessment and multidisciplinary interventions can help support early discharge and avoid hospital admission. We have seen a 20% rise in ED attendances locally, for older people – Frailty ACPs can support redesigned emergency pathways through a single point of access and coordinate care from admission to discharge.

Method

Patients referred to the acute frailty service (≥75 years, CFS score ≥5 presenting with a frailty syndrome) were assessed by a Frailty ACP along with further input from the MDT as required. The Frailty ACPs self identified patients who could have been discharged at this point. 

Results
21 patients were included with a mean age of 88 years (70-103 years) and mean CFS of 6 (range 4-8). 24% of patients were residing in a care home. 33% of patients presented with a fall. The reduction in length of stay if the patients could have been discharged by the ACP was 157 minutes. All patients were discharged at consultant review.  There were no readmissions with seven days. One patient died within seven days but this was expected and the patient had been discharged back to their care home for end of life care. 67% of discharges were supported by hospital at home.

Conclusion

Our pilot demonstrates that ACPs working within a defined area can safely reduce time spent in the emergency department, avoid hospital admission, improve SDEC performance and reduce overcrowding. Further work is needed to develop a framework to support autonomous practice.