2841 Moving CGA closer to the front door in St Georges emergency department. ‘Impact on length of stay and other outcomes.’

Emergency departments are increasingly seeing more older adults living with frailty. Between 5% and 10% of all those attending EDs and 30% of acute medical units are older adults living with frailty. The consequences of this on the system manifests as increased patient length of stay, poorer patient experience and clinical outcomes such as mortality and morbidity are measurably worse.

The Acute Frailty team aimed to move and expand its resource to provide a service to frail, older adults in both the Acute Medical Unit and the Emergency Department. This aligns with a key National objective that recommends all type 1 EDs have 70 hours access to a Acute Frailty Service. The team are a liaison service and therefore work alongside the ED and medical teams.

Quality improvement methodology was applied utilising multiple PDSA cycles. An incremental increase in provision of an Acute Frailty service within the ED. A stakeholder group was set up, KPIs were set. The team worked alongside the ED team to improve early CFS scoring for over 65 s and embedded the Nationally agreed same day frailty criteria of CFS/4AT, EWS and the presence of a frailty syndrome to identify appropriate patients for the service with the ED. The CGA was initiated in parallel with the ED assessment.

Time between admission and CGA decreased by ave. 30 hours. Time between CGA and dc from hospital decreased by ave. 1.6 days. Acute Frailty team activity increased in the ED and decreased in the AMU. No increase in re-admission rate was seen.

A CGA initiated in the ED had a positive impact on length of stay and the earlier dc did not increase readmission rates.