Acute frailty services: results of a national day of care survey.
Acute frailty services
Acute medical unit
Frailty
Prevalence
SAMBA
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
16 Jul 2024
16 Jul 2024
Historique:
received:
02
06
2023
accepted:
14
05
2024
medline:
17
7
2024
pubmed:
17
7
2024
entrez:
16
7
2024
Statut:
epublish
Résumé
Older people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement. The Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty. A total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39). There is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.
Identifiants
pubmed: 39014306
doi: 10.1186/s12877-024-05075-1
pii: 10.1186/s12877-024-05075-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
608Informations de copyright
© 2024. The Author(s).
Références
Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15. https://doi.org/10.1016/j.cger.2010.08.009 .
Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391(10132):1775–82. https://doi.org/10.1016/S0140-6736(18)30668-8 .
Hao Q, Zhou L, Dong B, Yang M, Dong B, Weil Y. The role of frailty in predicting mortality and readmission in older adults in acute care wards: a prospective study. Sci Rep. 2019;9(1):1207.
doi: 10.1038/s41598-018-38072-7
pubmed: 30718784
pmcid: 6362215
Kamwa V, Seccombe A, Sapey E. The evidence for assessing frailty and sarcopenia in an acute medical unit: a systematic review. Acute Med. 2021;20(1):48–67.
doi: 10.52964/AMJA.0841
pubmed: 33749694
Gilardi F, Scarcella P, Proietti MG, Capobianco G, Rocco G, Capanna A, et al. Frailty as a predictor of mortality and hospital services use in older adults: a cluster analysis in a cohort study. Eur J Public Health. 2018;28(5):842–6.
doi: 10.1093/eurpub/cky006
pubmed: 29590362
pmcid: 6148968
Welch C, McCluskey L, Wilson D, Chapman GE, Jackson TA, Treml J, et al. Delirium is prevalent in older hospital inpatients and associated with adverse outcomes: results of a prospective multi-centre study on World Delirium Awareness Day. BMC Med. 2019;17(1):229.
doi: 10.1186/s12916-019-1458-7
Long SJ, Brown KF, Ames D, Vincent C. What is known about adverse events in older medical hospital inpatients? A systematic review of the literature. Int J Qual Health Care. 2013;25(5):542–54.
doi: 10.1093/intqhc/mzt056
pubmed: 23925507
Joosten E, Demuynck M, Detroyer E, Milisen K. Prevalence of frailty and its ability to predict in hospital delirium, falls, and 6-month mortality in hospitalized older patients. BMC Geriatr. 2014;14:1.
doi: 10.1186/1471-2318-14-1
pubmed: 24393272
pmcid: 3905102
Subbe CP, Burford C, Le Jeune I, Masterton-Smith C, Ward D. Relationship between input and output in acute medicine - secondary analysis of the Society for Acute Medicine’s benchmarking audit 2013 (SAMBA ’13). Clin Med (Lond). 2015;15(1):15–9.
doi: 10.7861/clinmedicine.15-1-15
pubmed: 25650192
Hubbard RE, Peel NM, Samanta M, Gray LC, Mitnitski A, Rockwood K. Frailty status at admission to hospital predicts multiple adverse outcomes. Age Ageing. 2017;46(5):801–6.
doi: 10.1093/ageing/afx081
pubmed: 28531254
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.
doi: 10.1503/cmaj.050051
pubmed: 16129869
pmcid: 1188185
Theou O, Squires E, Mallery K, Lee JS, Fay S, Goldstein J, et al. What do we know about frailty in the acute care setting? A scoping review. BMC Geriatr. 2018;18(1):139.
doi: 10.1186/s12877-018-0823-2
pubmed: 29898673
pmcid: 6000922
Baztán JJ, Suárez-García FM, López-Arrieta J, Rodríguez-Mañas L, Rodríguez-Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ. 2009;338: b50.
doi: 10.1136/bmj.b50
pubmed: 19164393
pmcid: 2769066
Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017;9(9):Cd006211.
pubmed: 28898390
Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, et al. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review Age Ageing. 2018;47(1):149–55.
doi: 10.1093/ageing/afx166
pubmed: 29206906
National Health Service. The NHS Long Term Plan 2019 [Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf .
NHS Improvement NE, the Ambulatory Emergency Care Network and the Acute Frailty Network, . Same-day acute frailty services. 2019.
Knight T, Kamwa V, Atkin C, Green C, Ragunathan J, Lasserson D, et al. Acute care models for older people living with frailty: a systematic review and taxonomy. BMC Geriatr. 2023;23(1):809.
doi: 10.1186/s12877-023-04373-4
pubmed: 38053044
pmcid: 10699071
Holland M, Subbe C, Atkin C, Knight T, Cooksley T, Lasserson D. Society for Acute Medicine Benchmarking Audit 2019 (SAMBA19): Trends in Acute Medical Care. Acute medicine. 2020;19(4):209–19.
doi: 10.52964/AMJA.0829
pubmed: 33215174
Atkin C, Knight T, Subbe C, Holland M, Cooksley T, Lasserson D. Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit. BMC Health Serv Res. 2022;22(1):17.
doi: 10.1186/s12913-021-07355-7
pubmed: 34974842
pmcid: 8722290
The Society for Acute Medicine. SAMBA22 protocol
2022 [Available from: https://www.acutemedicine.org.uk/samba-2022-bookings-open/ .
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.
doi: 10.1136/bmj.39335.541782.AD
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
doi: 10.1016/j.jbi.2008.08.010
pubmed: 18929686
Stille K, Temmel N, Hepp J, Herget-Rosenthal S. Validation of the Clinical Frailty Scale for retrospective use in acute care. Eur Geriatr Med. 2020;11(6):1009–15.
doi: 10.1007/s41999-020-00370-7
pubmed: 32770462
Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.
doi: 10.1111/j.1532-5415.2007.01156.x
pubmed: 17493201
pmcid: 2409147
Royal College of Physicians of London. National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS. London: Report of a working party; 2012.
NHS Improvement and the Ambulatory Emergency Care Network. Same day emergency care: clinical definition, patient selection and metrics 2018 [Available from: https://www.england.nhs.uk/wp-content/uploads/2021/05/aec-same-day-emergency-care-clinical-definition-patient-selection-metrics.pdf .
Abel G, Elliott MN. Identifying and quantifying variation between healthcare organisations and geographical regions: using mixed-effects models. BMJ Qual Saf. 2019;28(12):1032–8.
pubmed: 31533954
pmcid: 6934242
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60(4):290–7.
doi: 10.1136/jech.2004.029454
pubmed: 16537344
pmcid: 2566165
Cassarino M, Robinson K, Trépel D, O’Shaughnessy Í, Smalle E, White S, et al. Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults: A randomised controlled trial. PLoS Med. 2021;18(7): e1003711.
doi: 10.1371/journal.pmed.1003711
pubmed: 34319971
pmcid: 8318294
Knight T, Atkin C, Kamwa V, Cooksley T, Subbe C, Holland M, et al. The impact of frailty and geriatric syndromes on metrics of acute care performance: results of a national day of care survey. EClinicalMedicine. 2023;66: 102278.
doi: 10.1016/j.eclinm.2023.102278
pubmed: 38192597
pmcid: 10772156
Quinn J, Buchanan S, Myint PK, Ellis G. Older patients are more likely to breach the 4-hour target in Scotland. Emerg Med J. 2020;37(12):807–10.
doi: 10.1136/emermed-2019-209099
pubmed: 32482758
Keeble E, Roberts HC, Williams CD, Van Oppen J, Conroy SP. Outcomes of hospital admissions among frail older people: a 2-year cohort study. Br J Gen Pract. 2019;69(685):e555–60.
doi: 10.3399/bjgp19X704621
pubmed: 31308000
pmcid: 6650131
Knight T, Malyon A, Fritz Z, Subbe C, Cooksley T, Holland M, et al. Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey. EClinicalMedicine. 2020;19: 100235.
doi: 10.1016/j.eclinm.2019.12.005
pubmed: 32055788
pmcid: 7005412
Knight T, Atkin C, Martin FC, Subbe C, Holland M, Cooksley T, et al. Frailty assessment and acute frailty service provision in the UK: results of a national ‘day of care’ survey. BMC Geriatr. 2022;22(1):19.
doi: 10.1186/s12877-021-02679-9
pubmed: 34979956
pmcid: 8721940
Church S, Rogers E, Rockwood K, Theou O. A scoping review of the Clinical Frailty Scale. BMC Geriatr. 2020;20(1):393.
doi: 10.1186/s12877-020-01801-7
pubmed: 33028215
pmcid: 7540438
Fox MT, Persaud M, Maimets I, O’Brien K, Brooks D, Tregunno D, et al. Effectiveness of acute geriatric unit care using acute care for elders components: a systematic review and meta-analysis. J Am Geriatr Soc. 2012;60(12):2237–45.
doi: 10.1111/jgs.12028
pubmed: 23176020
pmcid: 3557720