The British Geriatrics Society (BGS) has published a new resource aimed at supporting healthcare professionals who want to offer a front door frailty (FDF) service to older people presenting at emergency departments (EDs).
As pressure remains intense across health and social care services, evidence shows that older people wait longer than other age groups to be assessed in the ED and to be seen by a medical specialist. Older people who are admitted to hospital are more likely to face lengthy hospital stays and are often unable to be discharged because of a lack of social care or rehabilitation in the community. As winter approaches, the coming months are likely to be tough for the NHS and social care and it is with this in mind that BGS has published this resource with the hope that systems may find it helpful for their winter planning.
Identification of frailty at the hospital front door can help trigger early comprehensive geriatric assessment (CGA) and ensure that older people with frailty are diverted to the most appropriate services within the hospital as quickly as possible and, where possible, discharged home on the same day. As well as improving the experience and health outcomes of older people attending hospital, FDF services improve patient flow and reduce pressure on the whole hospital system.
There is no ‘right way’ to do FDF - the service provided will depend on factors such as the hospital estate, the workforce available and the needs of the local population. With this in mind, BGS has set out five principles that should underpin FDF services and provided a series of tips about establishing services from those who have been through the experience.
1. Prioritise the development of the service. This needs an appetite for change, and a focus on improved patient flow and early discharge, which help to demonstrate the potential impact of front door frailty.
2. Prove your need. A quality improvement mindset is necessary and a small pilot project can help to prove the service is needed and the difference it could make. Constant measurement is crucial to ensure ongoing cycle of improvement.
3. Map your organisation and consider intervention points. Every hospital is different, so understanding your hospital and the surrounding services and where front door frailty would fit within existing services is essential.
4. Identify frailty and trigger the start of CGA. Prioritising the early identification of people with frailty in the ED means CGA can be triggered as quickly as possible, ensuring older people with frailty receive rapid treatment by the most appropriate team.
5. Build relationships and plan the workforce. This means within the hospital and beyond, building trust between services to ensure front door frailty is embedded in the hospital. The service must be multi-disciplinary.
Dr Tom Downes, BGS Vice President for Clinical Quality, says: “Front door frailty services have had a positive impact everywhere they have been implemented effectively. They improve patient experience by reducing unnecessary admissions and helping older people to get back home the same day. Front door frailty services contribute to hospitals operating more efficiently with fewer people experiencing long waits in ED and fewer people getting delayed in hospital unable to be discharged. This resource shares the experiences of those who work in established services and is intended to support colleagues who wish to get started in this area. We very much hope that healthcare professionals across the country will find this useful as they work towards establishing front door frailty services.’
