AT A GLANCE
THE CHALLENGE
The CLEAR project focused on older people living with frailty attending UEC services with the aim of reducing unnecessary admissions and length of stay. Since the COVID-19 pandemic, the trust’s frailty service based at both Frimley Park Hospital and Wexham Park Hospital had experienced an increase in demand. More effective collaboration was needed between specialities, hospital sites and with community services. There were challenges with patient flow through the service which included the same day emergency care (SDEC), misaligned referrals and patients being unnecessarily admitted to acute beds. More training was needed on the frailty pathway and clinical frailty scale scoring.
WHAT THEY DID
The project, led by two frailty practitioners on secondment, followed CLEAR’s methodology: clinical engagement, data interrogation, innovation and recommendations. Over six weeks, the team made four site visits and interviewed 61 staff from nine organisations working across the frailty pathway from pre-admission to discharge – including GPs, district nurses, porters and ambulance teams. More than 14,000 emergency department (ED) attendance records were analysed.
CLEAR RECOMMENDATIONS
The project made six key recommendations – these included unifying the frailty service with a streamlined pathway for patients both in and out of hours, a frailty co-ordinator streaming in the ED to identify patients earlier and more routine screening and assessments to be carried out in the department and the acute medical unit (AMU) to promote early discharges.
Frailty service hours could be extended to 8am–8pm seven days a week at both hospitals and the SDEC and the frailty team moved closer to the ED to improve efficiency and collaboration with the ED and AMU. A new training role could be created who would be responsible for promoting a proactive approach to frailty, developing champions and leading mandatory training for staff.
Other recommendations included collaboration with community teams to streamline referral and discharge processes, and improvements to the trust’s IT system to standardise the coding of patients and enhance team efficiency.
FORECAST IMPACT
The more proactive approach in ED would result in patients being identified and assessed earlier by frailty staff – streaming patients to SDECs, resulting in a reduction in long waits and avoiding unnecessary hospital admissions. Increasing the frailty service’s hours would meet the increased demand of frail patients.
Collaboration and communication within the trust and wider system would improve. It’s predicted that staff satisfaction and retention would increase from an enhanced service and the opportunity to develop additional skills.
It’s projected that 16,759 bed days would be saved resulting in a potential productivity saving of £4.6m including a reduction in length of stay. This saving could rise to £5m by extending the hours of the frailty service and through admission avoidance.
