(withdrawn) Integrating Frailty Care into Acute Hospital Workflow through Practice Based Research

Purpose:
Research: Epidemiology of frailty; evaluation of interventions on patient outcomes; evaluation of organizational outcomes Quality Improvement: Early identification of frailty; prompt and individualized provision of care; follow along and discharge hand off; spread and sustainability

Background/Significance:
Frailty often triggers a cascade of events leading to functional decline, exacerbation of chronic illness, hospital admission and all too often readmissions. While a hospital episode is a significant health event, it also presents an opportunity for the care team to identify frailty and attenuate adverse outcomes with prompt, individualized approaches to care. We developed two strategies with the goal of integrating interdisciplinary geriatric care into the usual work flow of inpatient units.

Methods:
Implementation of a frailty test of change was piloted on one nursing unit with roll-out anticipated to 15 additional units by the end of the fiscal year 2012. Evaluation consisted of process measures; pre and post implementation changes and impact on rates of adverse hospital outcomes, length of stay and readmissions.

Results:
1524 nurses participated in a NICHE® organizational assessment. Post assessment 270 nurses achieved Geriatric Resource Nurse (GRN) credential and 36 ANCC certification in Gerontological Nursing. In tandem, a multi-disciplinary workgroup has implemented a test of change on a general medical unit with a 75% geriatric population. The core frailty team developed processes and work flows to provide care recommendations for patients screened at risk by the primary nurse. 183 patients have been screened and identified with frailty related risks; with 82 included in the test of change and provided further inter-professional team risk assessment and recommendations for intervention

Conclusions and Implications for Practice:
Preliminary results suggest risk identification and early intervention may be transferred to usual processes. Nursing can take a leadership role in identification and coordinating intervention for patients that can expand beyond the acute care hospitalization into post-discharge transitional care.