Frailty is highly prevalent in hospitalized older adults and predicts adverse health outcomes but remains under-recognized. Manual screening tools previously employed were challenging in high-volume settings and reliant on individuals’ knowledge on frailty. With the development of electronic health records (EHRs), there is a potential to automate screening for frailty in hospitalized older adults. We introduce a quality improvement initiative that utilizes an EHR-automated Best Practice Advisory (BPA) alert to identify inpatients who may benefit from geriatric intervention and encourage timely Geriatric referral to a Mobile Frailty Intervention Team (MFIT). MFIT was piloted at Woodlands Hospital, an integrated acute and community hospital in Singapore. BPA was automatically triggered to encourage referral to MFIT if any of the following criteria were met a) Clinical Frailty Scale (CFS) ≥ 7 b) CFS 5–6 with presence of either of cognitive impairment / high falls risk / high readmission risk c) Age ≥ 60 with presence of delirium, regardless of CFS status. The MFIT team conducted Comprehensive Geriatric Assessments (CGA) as part of routine review with the diagnosed geriatric syndromes and discharge dispositions recorded. On MFIT review, 81.3 % ( N = 248) of patients referred had a geriatric syndrome and 68.5 % ( N = 209) had multiple syndromes. MFIT further identified syndromes which may be neglected during acute admission such as underlying dementia (87 %, N = 83), osteoporosis (13.4 %, N = 41) and urinary incontinence (9.8 %, N = 30). MFIT also provided discharge recommendations which were adhered to in 79.2 % ( N = 232) of patients. 32.8 % ( N = 100) were given specialized outpatient clinic follow-up with Geriatric medicine, suggesting the potential to divert patients from away from primary care services and unplanned readmissions. Further studies are needed to investigate whether this transition effectively optimizes resource allocation. A CFS-based BPA alert may be feasible in providing an automated and scalable method to identify hospitalized older adults with frailty that would benefit from timely geriatric intervention.
Teo et al. (Sat,) studied this question.