A J Burgess, A Hassan, D J Burberry, N Dorsett, A Bari, E A Davies


  • Geriatrics and Gerontology
  • Aging
  • General Medicine

Abstract Aim We proposed that the Hospital Frailty Risk Score (HFRS) could identify patients attending the Emergency Department (ED) who would benefit from our Older Persons Assessment Service (OPAS). Identifying older people at risk of adverse outcomes in hospital can allow a system to provide frailty-specific interventions throughout their stay. Methods OPAS (ED-based) accepts patients with frailty syndromes aged >70 years. All patients receive a contemporaneous Clinical Frailty Score (CFS) following multidisciplinary assessment. A retrospective analysis of the OPAS databank was conducted using HFRS to divide patients in High/Intermediate and Low Frailty Risk. We considered Age, CFS, Postcode with Welsh index of multiple deprivation, length of stay (LOS) and 12-month mortality. Results 700 consecutive admissions: 400 High/Intermediate and 300 Low HFRS. High/Intermediate HFRS vs Low HFRS had similar deaths (p=0.2) but significant difference in CFS (p<0.05). HFRS was able to detect frailty in those <75 years old (p<0.01) but not at ≥76 (p=0.08). There was no association between postcode with frailty or Death. HFRS Sensitivity: 0.44, Specificity: 0.83, Positive Predictive Value: 0.66, Negative Predictive value: 0.34, Area Under Curve: 0.39. Conclusion The HFRS identified 57% of the retrospective OPAS cohort, with the addition of >80yrs of age, the modified score identifies >85% of service users. Of those admitted, High/Intermediate Frail had median LOS of 28.11 days vs 21.26 days for not frail, with 30-day mortality 10.12% vs 8.90%; potentially suggesting the HFRS can identify a subpopulation of high-risk frail patients. We found socio-economic status, quality of discharge summaries and coding had no relationship to the screening efficacy of HFRS. We have developed an electronic, automated Frailty Flag that operates in real-time to signpost appropriate patients who would benefit from comprehensive geriatric assessment which we have tested in clinical practice. HFRS can be used to measure frailty-specific intervention system efficiency.

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