Utilising frailty scoring in the acute hospital setting to identify frail and vulnerable patients AIM Our objective is to operationalize a clinically usable tool, frailty early warning score (FEWS), which will identify frailty and help predict significant outcomes, including readmission, length of stay (LOS) transfer to higher level of care and mortality.
FEWS is based on a frailty model described by Soong et al (2015) with four specific domains (physical, mental, social and environmental, as illustrated in figure 1). Between 03 June 2015 and 27 August 2015, 700 acutely admitted patients over the age of 65 were reviewed. Data were collected from clinical notes taken routinely as part of the emergency admission process. No new data were collected. All data were collected electronically through bespoke software by Thinkshield and innate hospital programs. The national early warning scores (NEWS) were simultaneously collected for comparison.
700 patients were included (52.6% female) with an average age of 81 years. 94% were medical admissions (including orthogeriatric patients). 30 day mortality was 3.0%, 30 day readmission rate was 16.1% and the average length of stay (LOS) was 12.3 days (Table 1). 280/700 (40.0%) patients aged > 80 had >3frailty score, whereas ages 65-80; 96/700 (13.7%) had a frailty score of 0. Table 1 provides additional patient demographics. NEWS and FEWS were cross-tabulated: 246 admissions scored < 3 on NEWS (i.e. this would not trigger escalation), of which 206 scored ≥1 on the frailty tool. This could indicate a potential threshold for frailty escalation.
This study describes FEWS as a novel way of predicting a frail individual’s outcomes. This score can be easily calculated at the point of care using routinely corrected data. It is fast and simple to use; it will not require additional clinical assessment. Further work is needed to determine the weight of each domain and sub-domain, as this will be needed to define the sensitivity of the final aggregate score.
This research is limited to secondary use of information previously collected in the course of normal care. The patients or service users were not identifiable to the research team carrying out the research.
This abstract presents independent research commissioned by the National Institute for Health Research (NIHR) under the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for North West London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.