Improving Care of Inpatients Living with Frailty on a Vascular Ward Through introduction of a Multidisciplinary Board Round

Introduction

The British Geriatrics Society and Vascular Society recommend regular multidisciplinary team (MDT) discussions to improve care. Frailty affects approximately one-third of Vascular Surgery (VS) inpatients at GHNHSFT, yet the ward lacked a regular MDT meeting. Using a structured MDT board round, this quality improvement (QI) project aimed to improve frailty identification and management, to reduce median length of stay (LOS) for VS inpatients by 10% over six months.

Methods

Using QI methodology, four key drivers were identified: early frailty identification, proactive discharge planning, timely MDT input and ownership of actions. MDT stakeholders co-designed the intervention.

Two Plan-Do-Study-Act (PDSA) cycles were undertaken: (1) introduction of a structured twice-weekly MDT board round; (2) standardised electronic documentation of actions

Primary outcome measures were median LOS and proportion of patients living with frailty reviewed by therapy within 72h. Process measures (audited at three timepoints) included Clinical Frailty Scale (CFS) documentation and Geriatric Medicine (GM) referral quantity and quality. Balancing measures included board-round duration and 30-day readmission rate.

Results

Continuous data from 427 admissions showed median LOS decreased from 6.0 to 5.0 days (16.7%) following two PDSA cycles over four months. CFS documentation improved from 23% (3/13) to 40% (6/15) with an increase in referrals to GM from 15% (2/13) to 29% (4/14) after PDSA1 and 20% (3/15) following PDSA2; referrals asking a clear clinical question increased from 50% (1/2) to 100% (4/4). Board rounds consistently lasted under 20 minutes. Therapy reviews within 72h did not improve and 30-day readmission rates increased (7.8% to 14.4%), prompting review.

Conclusions

An MDT board round was successfully embedded within a busy VS ward, improving frailty identification and specialist referrals while reducing median LOS. Further PDSA cycles are planned, after review of readmissions, including a 'Frailty Bundle' trigger. Wider implementation could improve care for patients living with frailty across surgical specialties.