New Frailty Intervention Teams introduced to A&E to improve elderly care

Tuesday July 9, 2019

New Frailty Intervention Teams (FIT) have been introduced in the in the trust’s emergency departments to provide additional specialist support for our older and more frail patients. 

The teams, which include a frailty practitioner, supported by a consultant geriatrician, see patients in minors, majors, resus and the clinical decisions unit, depending on patient need.

It’s like an MOT or a full check-up for older patients

They work alongside the A&E medics, nurses and occupational therapists to provide specialist care for elderly patients who have been triaged in A&E as being frail.

This is a growing cohort of patients. For example, in May, attendance of over-85-year-olds was nearly 20% higher than in the same month the year before.

Our most frail patients will now receive a comprehensive geriatric assessment (CGA) by the FIT, which includes a physical, functional, social, environmental and psychological assessment, as well as a medication review. 

Clinical director of elderly care, Dr David Hunt, said: “It’s like an MOT or a full check-up for older patients. We reduce your risk of falling, we optimise your medication and we look at your bone health. We ensure you have appropriate support at home and involve all the various parts of the multidisciplinary team as is appropriate.”

In Worthing, the frailty practitioner is Sally Howard, a senior physiotherapist by background, supported by acute frailty consultant Dr Charlotte Kirk. The frailty practitioner at St Richard’s is senior occupational therapy practitioner Jo Pickett, supported by consultant community geriatrician Dr Jackie Pace.

Their aims are to enhance the provision of specialist frailty services at the front door of the hospitals to ensure that appropriate clinical intervention is provided earlier on, to either avoid hospital admissions or reduce length of stay.

FIT member Sally Howard said: “We are able to spend more time with these patients and already this project has enabled patients to return home sooner.”

Jo Pickett cited one example of an 85-year-old man who had attended A&E three times in just two weeks with reduced mobility due to pain. A&E had met his medical needs and he was deemed fit for discharge, but due to a high frailty score the frailty practitioner was alerted.

Jo said: “The patient had a full review of his functional, environmental and social care needs and it was felt that he would benefit from a return to our Rapid Access Clinic. Once there, the geriatrician could review all the findings from A&E to establish if any further assessments or changes were needed to enhance the patient’s care.

“Both he and his family were very grateful for this opportunity and he now has some further investigations planned as a result of clinic findings and he will return to St Richard’s as an outpatient. Importantly, he has not attended St Richard’s A&E since we intervened.”

The establishment of FIT in A&E is supported by evidence which suggests patients who have had a CGA are more likely to be alive and living in their own home at 3-12 months after leaving hospital.

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