The Acute Frailty Registrar Role – A Hutt Valley DHB initiative
Authors: Horton, K., Hutt Hospital, Lower Hutt, New Zealand (Presenter) Sullivan, V., Hutt Hospital, Lower Hutt, New Zealand Thompson, T., Hutt Hospital, Lower Hutt, New Zealand Rodwell, J., Hutt Hospital, Lower Hutt, New Zealand Linton, A., Hutt Hospital, Lower Hutt, New Zealand
Introduction: The Acute Frailty Registrar role was a 6 months initiative aimed at improving the care of the elderly by supporting identified Frail Patients in the community, primarily those discharging from ED. The aim was reduced Emergency department (ED) presentations, reduced hospital admission, higher likelihood of the frail patient living independently, increased patient/family and ED staff satisfaction.
Methods: Employment of a registrar Dec 2019 until June 2020 to provide timely review of frail patients discharging from the ED or in the community. Service hours 0800-1600, Monday to Friday. Comprehensive Geriatric Assessment was completed either in ED or at home. Outcomes measured: 1) Number of ED presentations within 30 days of review, 2) Hospital admission within 30 days of review, 3) 30 Day mortality 4) Place of residence within 3 months of assessment, with comparison made to the same period the year prior. Qualitative feedback included: 1) Patient and family survey, 2) Health professional survey.
Results: Data was to be collected over 23 weeks from Monday 16th December 2019. Collection was interrupted with COVID-19 resulting in only 13 weeks of data collected. During this period, 30 day ED representation rate reduced from 28.4% to 25.58% compared to the previous year (p=.83), 30 day hospital admission rates was 24.44% compared to 23.46% (p=1), 30 day mortality increased to 7% from 0% (p=.04), while 97% of patients were living at home at 3 months compared to 84% from the previous year (p=.33). Qualitative feedback from both patient/families and Health professionals identified high satisfaction ratings.
Conclusions: Frail patients discharged from ED who were reviewed by the frailty registrar were less likely to present to ED and more likely to remain in their own environment. However, a slight increase in 30-day mortality was observed. The numbers were small for statistical analysis and the pilot was impacted by COVID-19. There was a high level of satisfaction by patients/families and health professionals for the Acute Frailty Registrar role. This role should be further evaluated.
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