101
Early MDT Intervention and Improved Care Pathways for the Frail Older Person in a Rehabilitation Hospital Purchased

Background

The National Clinical Programme for Older People stipulates that frailty screening is a critical component of the Comprehensive Geriatric Assessment. To ensure best practice, new care pathways were introduced to facilitate timely and effective management of adults (>65 years) admitted to Clontarf Hospital for rehabilitation. We aimed to assess frailty, length of stay (LOS) and discharge outcome; and determine if early MDT identification of frail patients facilitates efficient discharge planning.

Methods

A prospective study was conducted from August 2016 to March 2017 inclusive. Data was collected from two rehabilitation wards that received patients (>65 years) from two acute teaching hospitals. A frailty screen proforma, combining the Clinical Frailty Scale (Rockwood) and Fried’s Frailty Phenotype model, was designed and used by physiotherapists at initial patient assessment. Data on patient demographics, living arrangements, LOS, pre-admission home supports, discharge outcome/destination were collated. From December 2016 to March 2017, a new frailty pathway was introduced whereby patients with a score of ≥3 on the proforma were referred immediately to other MDT services.

Results

262 patients were included, mean age at 81 years (range 65–98 years). Females predominated at 78.6% (n = 206). 67% (n = 176) were classified as ‘Frail’, 31% (n = 81) as ‘Pre-Frail’ and 2% (n = 5) as ‘Not Frail’. 49% (n = 128) lived alone. 46% (n = 37) of the ‘Frail’ group required either a new or increased home supports on discharge compared to 23% (n = 20) of the ‘Pre-Frail’/‘Not Frail’ group. Average LOS pre/post-implementation of the frailty care pathway was 44 and 31 days respectively (p = 0.0005). Discharge destinations: 80% (n = 210) home, 15% (n = 40) returned to parent hospitals (acute medical issues) and 3.1% (n = 8) for long term care.

Conclusions

Early identification of frail patients and comprehensive MDT intervention facilitated more structured and planned discharges and statistically significant reduction in patient LOS.