Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, NIHR Applied Research Collaborative West Midlands, NIHR Patient Safety Research Collaborative West Midlands, University of Birmingham, Birmingham, England.
The Christie NHS Foundation Trust, Manchester, England.
BMC Geriatr. 2024 Jul 16;24(1):608. doi: 10.1186/s12877-024-05075-1.
Older people living with frailty are at high risk of emergency hospital admission and often have complex care needs which may not be adequately met by conventional models of acute care. This has driven the introduction of adaptations to acute care pathways designed to improve outcomes in this patient group. The identification of differences in the organisational approach to frailty may highlight opportunities for quality improvement.
The Society for Acute Medicine Benchmarking audit is a national service evaluation which uses a single day-of-care methodology to record patient and organisational level data. All acute hospitals in the United Kingdom are eligible to participate. Emergency admissions referred to acute medical services between 00:00 and 23:59 on Thursday 23rd June 2022 were recorded. Information on the structure and operational design of acute frailty services was collected. The use of a validated frailty assessment tool, clinical frailty scale within the first 24 h of admission, assessment by an acute frailty service and clinical outcomes were reported in patients aged 70 year and above. A mixed effect generalised linear model was used to determine factors associated same-day discharge without overnight stay in patients with frailty.
A total of 152 hospitals participated. There was significant heterogeneity in the operational design and staffing model of acute frailty services. The presence of an acute frailty unit was reported in 57 (42.2%) hospitals. The use of validated frailty assessment tools was reported in 117 (90.0%) hospitals, of which 107 (91.5%) used the clinical frailty scale. Patient-level data were recorded for 3604 patients aged 70 years and above. At the patient level, 1626 (45.1%) were assessed using a validated tool during the admission process. Assessment by acute frailty services was associated with an increased likelihood of same-day discharge (adjusted OR 1.55, 95%CI 1.03- 2.39).
There is significant variation in the provision of acute frailty services. Frailty-related policies and services are common at the organisational level but implemented inconsistently at the patient level. Older people with frailty or geriatric syndromes assessed by acute frailty services were more likely to be discharged without the need for overnight bed-based admission.
患有虚弱症的老年人有急诊住院的高风险，通常有复杂的护理需求，而传统的急性护理模式可能无法充分满足这些需求。这促使人们引入了对急性护理途径的调整，以改善这一患者群体的治疗效果。识别出在虚弱症管理方面的组织方法差异可能会突出质量改进的机会。
急性医学学会基准测试审计是一项全国性的服务评估，它使用单日护理方法记录患者和组织层面的数据。英国所有的急性医院都有资格参与。2022 年 6 月 23 日星期四 00:00 至 23:59 之间转至急性医疗服务的急诊入院患者都被记录下来。收集了有关急性虚弱服务的结构和运营设计的信息。在 70 岁及以上的患者中，报告了在入院后 24 小时内使用经过验证的虚弱评估工具（临床虚弱量表）、由急性虚弱服务进行评估以及临床结果。使用混合效应广义线性模型来确定与虚弱患者当天出院且无需过夜的相关因素。
共有 152 家医院参与。急性虚弱服务的运营设计和人员配备模式存在显著差异。报告有 57 家（42.2%）医院设有急性虚弱病房。报告有 117 家（90.0%）医院使用了经过验证的虚弱评估工具，其中 107 家（91.5%）使用了临床虚弱量表。记录了 3604 名 70 岁及以上患者的患者水平数据。在患者层面，1626 名（45.1%）患者在入院过程中使用了经过验证的工具进行评估。接受急性虚弱服务评估与当天出院的可能性增加相关（调整后的比值比 1.55，95%置信区间 1.03-2.39）。
急性虚弱服务的提供存在显著差异。组织层面上虚弱相关政策和服务很常见，但在患者层面上实施不一致。由急性虚弱服务评估的虚弱或老年综合征老年人更有可能无需过夜床位入院即可出院。
