Improving Completion of the Comprehensive Geriatric Assessment in Frailty Post-Take Ward Rounds

Introduction:

The Comprehensive Geriatric Assessment (CGA) is a cornerstone of good quality geriatric medical care. It enables identification of the medical, functional, cognitive and social needs of older people accessing healthcare. Frailty post-take ward rounds (PTWRs) provide an important opportunity for geriatricians to establish and record components of the CGA. We aimed to assess the documentation of selected GCA domains during frailty PTWRS and improve their completion through specific interventions.

Method:

A two-cycle quality improvement project was conducted over a six-month period using the Plan-Do-Study-Act (PDSA) methodology. Sixty-five patients reviewed on the frailty PTWR were audited across both cycles. Documentation of five key components of the GCA were evaluated: Clinical Frailty Score (CFS), 4AT delirium score, mood assessment, anticholinergic burden, and social history. Usage of a pre-existing CGA proforma was also recorded. After our initial data collection, interventions included the development of a new online CGA proforma, departmental education, and creation of a poster displayed in clinical area. A second audit cycle evaluated the impact of these interventions.

Results:

Documentation improved across all assessed domains in the CGA after our interventions. 

CFS documentation increased from 52.4% to 61%, 4AT documentation from 50.8% to 69.5%, social history from 82.5% to 94.9%, anticholinergic burden from 1.6% to 6.8%, and mood assessment from 1.6% to 5.1%. Despite overall improvement, utilisation of the new CGA proforma decreased slightly from 30.2% to 27.1%. The following barriers to completion of the CGA on frailty PTWRs were identified: time pressures, a high volume of patients, and documentation burden.

Conclusion: 

Educational interventions and introduction of a simplified CGA proforma improved documentation of key CGA domains during frailty PTWRs. However, use of the proforma remained limited, highlighting the challenge of continued clinical change in a busy acute care setting. Future work would include identifying barriers to proforma use, further staff education, and integration of members of the MDT.