From the Guidelines
To efficiently run a frailty Short-Stay Decision to Admit and Evaluate Clinic (SDEC) with 6 chairs and a 26-bed short stay unit in the NHS, implement a comprehensive multidisciplinary approach with clear patient pathways, prioritizing orthogeriatric comanagement and multidisciplinary care as recommended by recent guidelines 1. This approach should include dedicated frailty teams consisting of geriatricians, specialist nurses, therapists, pharmacists, and social workers who can rapidly assess and manage elderly patients. Utilize standardized frailty assessment tools like the Clinical Frailty Scale or Rockwood Scale for consistent patient evaluation, as simple frailty screening instruments are showing a resurgence 2. Develop clear admission criteria focusing on patients who need urgent assessment but may not require prolonged hospitalization. Implement twice-daily multidisciplinary rounds to ensure timely decision-making and discharge planning, and create efficient patient flow processes with target lengths of stay of under 72 hours for the short stay unit and same-day assessment and discharge for SDEC chairs. Establish strong community links with rapid access to home care services, community rehabilitation, and follow-up clinics, and use electronic health records with frailty-specific templates to streamline documentation and communication. Develop comprehensive discharge protocols including medication reconciliation, follow-up appointments, and community support arrangements, considering that inappropriate medications are often prescribed for those with frailty, and frailty associates with medication harm 2. This approach maximizes limited resources while providing appropriate care for frail patients, reducing unnecessary hospital admissions and complications associated with prolonged hospitalization in this vulnerable population. Some key considerations include:
- Strength-based training remains the most effective strategy to combat frailty, with exercise modes improving frailty outcomes including computerised-based training, exergames, inspiration and body vibrational training, muscle power training, and dance 2
- Multidimensional interventions might prevent progression to frailty (from pre-frailty) in those ≥ 80 years, and home-based exercises combined with health education and telephone support can reduce sedentary time 2
- Integrated care appears to improve physical function in older adults with frailty except when usual care is of high quality 2
- Frailty status can fluctuate substantially, and this change is more predictive of mortality than current frailty status, and distinct frailty trajectory groups have been found 2
From the Research
Efficient Management of Frailty SDEC 6 Chairs and Short Stay Unit 26 Beds in the NHS
To manage a frailty SDEC 6 chairs and short stay unit 26 beds in the NHS efficiently, several factors need to be considered, including the management of polypharmacy, frailty assessment, and individualized patient care.
- Polypharmacy Management: Polypharmacy is a significant issue in older adults with frailty, increasing the risk of adverse drug reactions 3, 4. The periodic review of drugs and reduction of dose or discontinuation of potentially inappropriate medications are necessary to address this problem 3. Tools such as the Beers, STOPP, and START criteria, and the Medication Appropriateness Index can help identify potentially inappropriate medication use 5.
- Frailty Assessment: Frailty assessment is crucial in identifying patients at risk of adverse outcomes 6, 7. A comprehensive geriatric assessment can identify risk factors and symptoms that suggest frailty 6. Several validated frailty assessment tools can evaluate a patient for frailty, and patients are diagnosed as not-frail, prefrail, or frail 6.
- Individualized Patient Care: The management of frail patients must be individualized and tailored to each patient's goals of care and life expectancy 6. Physical activity and balance exercises may be suitable for patients who are less frail, while palliative care and symptom control may be appropriate for those who are more frail 6.
- Deprescribing: Deprescribing is a therapeutic intervention that can help reduce polypharmacy risks 5. Physicians should consider patient/caregiver perspectives on goals of therapy and use point-of-care tools to aid in deprescribing 5.
- Structured Screening: Detection of frailty should lead to structured screening for inappropriate prescribing, and detection of potentially inappropriate prescribing should trigger screening for frailty 4.
By considering these factors and implementing efficient management strategies, the NHS can provide high-quality care to patients with frailty in the SDEC 6 chairs and short stay unit 26 beds.