Introduction The over 75 s make up 20% of our ED attendances. The greatest increase has been in the over 85 s. This very elderly cohort are more likely to be frail and are 10X more likely to require admission than 20–40 year olds and once in hospital have longer stays. There is evidence that multidisciplinary care and early Comprehensive Geriatric Assessment (CGA) improves outcomes for older patients, reducing readmissions, long term care, greater satisfaction and lower costs. The aim of this project was to improve the acute care provided to our older patients at the Front Door of the hospital.

Methodology 3 month pilot project underpinned by Big Room Quality Improvement methodology. The Frailty Big Room meets weekly and includes input from clinicians, QI experts and a data analyst. This project was driven by the following aims:

• Frailty Flying Squad to see as many older±frail patients referred for admission as close to the front door as possible.

• CGA at the front door with discharge planning from first review

• MDT approach

• Expedited discharge or transfer to other services from ED.

• Review following day to make sure management plans being followed through or discharge without ward teams having to become involved.

• Frailty Flying Squad Team:

  • 2 Medical Nurse Practitioners

  • Physiotherapist

  • Consultant geriatrician

• Key Performance Indicators:

  • Length of Stay

• Readmission within 30 days of initial review

Results 355 patients were seen. 168 (47%) of patients were over 85 and the median Rockwood frailty score for the whole cohort was 6. 209 patients were ED referrals and 85 were GP referrals for admission. 237 (67%) patients were seen in ED, 49 in MAU and 7 in ED obs. During the pilot period, 97 patients who had been referred for admission were discharged direct from ED. 56 (16%) of patients had zero length of stay. A low number (9.4%) of patients were readmitted within 30 days.

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Figure 1

LOS

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Figure 2

Length of stay for the > 85s 2016 and 2017 compared

Conclusion A multidisciplinary Acute Care of the Elderly Team predominantly based in the Emergency department can provide effective early Comprehensive Geriatric Assessment; facilitating discharge home from the Emergency Department, reducing length of stay for those admitted and reducing readmission rates within 30 days.