Heartbeat: An integrated approach to frailty at the front door

September 21, 2020

‘Providing the right care, in the right place at the right time’, is a term that’s often used in the NHS. One area it can make a significant impact in is when it comes to caring for our older patients who present at our hospitals – an issue that has been proven by our frailty at the front door work.

With an ageing population alongside high levels of deprivation and ill health in Sandwell and West Birmingham, it’s critical to ensure that when a frail older adult is admitted into our care that we act rapidly to ensure that therapy intervention and discharge planning begins as early as possible so the right level of care is in place and the patient begins their journey to discharge.

To find out more about the frailty at the front door project, Heartbeat caught up with Trainee Frailty Advanced Clinical Practitioner, Emma Hibbs.

She said: “Early intervention therapy is key when it comes to caring for our population, which is why the rapid response therapy service is in ED supporting colleagues to care for patients. Our teamwork has two primary aims in ED; admission prevention and early comprehensive therapy assessment.

“The rapid response therapy team are now well established in ED – acute medical assessment units and the older person’s assessment unit, work collaboratively as part of the multidisciplinary team and proactively manage patients across these units to provide therapy assessments and facilitate discharge planning.

“As a team, we have been able to continually evolve our assessments focusing on the quality of care we give to our patients. We screen for frailty using the clinical frailty scale, complete evidence based cognitive assessments such as the 4AT to screen for delirium and cognitive impairment and complete a thorough physical and functional assessment.

We know that admission to hospital and/ or prolonged acute inpatient stay can negatively impact function, overall patient outcomes, mortality, and whether patients return to their usual place of residence or not. We can have meaningful conversations about what matters to our patients to inform our assessment and management to ultimately provide holistic care.”

Emma added: “Since the project, we have made some exciting developments around the management of frailty at the front door with a successful project piloting a ‘frailty intervention team’ in ED in July. The primary aim of this team was to deliver comprehensive geriatric assessments facilitated by a core MDT group of clinicians. The pilot was a great success, and we look forward to hopefully establishing this service permanently in ED working towards a vision of a truly integrated front door approach to frailty.”