Improving Documentation of Comprehensive Geriatric Assessment on Discharge from a Frailty Unit
Abstract
Introduction
Comprehensive geriatric assessment (CGA) should be performed in all patients admitted to a specialist frailty unit. All interventions should be documented and communicated to community teams to allow continuous and safe care. A lack of CGA documentation was highlighted on our hospital discharge summaries.
Method
A discharge template was designed to include eight key aspects of CGA, including clinical frailty score (CFS), functional assessment, medication review, cognition, continence, bone health, postural blood pressure and advance care planning (ACP). We collected baseline data on template use and documentation of CGA on discharge from the frailty unit. We completed two PDSA cycles with use of targeted education to resident doctors in cycle one and education of senior nursing staff and allied healthcare professionals at our daily multi-disciplinary meetings in cycle two.
Results
Baseline data collected on 28 patients revealed an average patient age of 83 and an average CFS of 5.6. The discharge template was used in 1 case (3.6%) with all aspects of CGA documented. On discharge summaries, CFS (14.3%) and functional assessment (10.7%) were poorly documented. Continence was documented in 1 case (3.6%). ACP discussions including completing a DNACPR occurred in 17 cases (60.7%), with only 10 (35.7%) cases having these discussions documented on discharge.
After 2 PDSA cycles, a further data collection of 12 patients revealed increased use of the discharge template (66.7%). Documentation of CFS improved (75%) as well as improvement in documentation of functional assessment (58.3%) and continence (58.3%). All patients who had ACP discussions in hospital had this documented on their discharge summary.
Conclusion
The use of a discharge template is effective in improving documentation of CGA. Targeted education is a useful tool to improve template use. Further interventions including the use of visual aids and appointing a ward champion are planned to allow completion of further PDSA cycles.