Implementation of a Frailty Assessment and Care Interventions for Elderly Surgical Patients
Spencer Wilson, Evan Sutherland, Callie Ding, Alina Razak, Thien Nguyen, Mollie O'Brien, Pamela Rosenkranz, Sabrina Sanchez
Boston Medical Center, Boston, MA, Boston, MA
Background: The burden of surgical disease from elderly patients is expected to increase in coming decades and elderly patients with frailty syndrome have a greater risk of poor post-operative outcomes. In this study, we sought to implement an assessment tool to identify frail patients as well as an intervention to provide targeted interventions.
Methods: The intervention in this study was the implementation of a five-question frailty score for elderly surgical patients admitted to the general and vascular surgery departments in an urban, safety-net hospital from January 2018 to December 2019. Frail patients received a bundled set of evidence-based clinical orders and nursing interventions tailored to optimize recovery. Implementation effectiveness was assessed through provider and nurse surveys, floor audits, and chart review.
Results: Out of 1158 patients who were included in the study, the frailty assessment was completed on 696 patients. There were 611 patients scored as frail. Frail patients were significantly more likely to receive bundled interventions. Lack of time was the largest barrier to assessment completion by providers. Floor audits showed that there was high variation in completion of care plan components by nursing staff. Frail patients had higher inpatient complications and less favorable discharge dispositions but no differences in 30-day mortality.
Conclusion: A frailty assessment was able to identify elderly patients at high risk of post-operative complications, but limited uptake of the assessment by providers and completion of care plan components by nursing staff were significant barriers in implementation.
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