FRAILTY SCREENING AND A FRAILTY PATHWAY DECREASE LENGTH OF STAY, LOSS OF INDEPENDENCE, AND 30-DAY READMISSION RATES IN FRAIL GERIATRIC TRAUMA AND EMERGENCY GENERAL SURGERY PATIENTS

Background Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of post-discharge institutionalization than their non-frail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement (QI) project was to first develop a frailty screening program, and, then, if frail, implement a novel Frailty Pathway to reduce LOS, 30-day readmissions, and loss of independence (LOI). Methods This was a before-after study of a prospective cohort of all geriatric (≥65 years old) patients admitted to the TEGS service from 10/2016-10/2017. All patients were screened for frailty for 3 months (pre-intervention) to obtain baseline outcomes. Subsequently, frail patients were entered into our Frailty Pathway (post-intervention). Non-parametric statistical tests were used to assess significant differences in continuous variables; chi-squared and Fisher’s exact tests were used for categorical variables, where appropriate. Both process and outcome measures were evaluated. Results Of 239 geriatric TEGS patients screened, 70 (29.3%) were frail. All TEGS geriatric patients were screened within 24 hours of admission. Following Frailty Pathway implementation, median length of stay for frail patients decreased from 9 to 6 days (p=0.4), readmissions decreased from 36.4% to 10.2% (p=0.04), and loss of independence decreased by 40%, (100% vs 60%; p=0.01). Outcomes for non-frail geriatric patients did not differ between cohorts. Conclusions Screening for frailty followed by implementing a Frailty Pathway decreased LOS, LOI and 30-day readmission rates for frail geriatric TEGS patients at a single urban academic institution. The pathway required no additional resources; rather, we shifted focus toward frail patients, without negatively affecting outcomes in non-frail geriatric TEGS patients. Implementation of this pathway with larger patient cohorts and in varied settings is needed to confirm a causal relationship between our intervention and improved outcomes. Level of evidence Level IV Study type Prospective time series study Corresponding author: Joseph Posluszny, MD, Assistant Professor of Surgery, Northwestern University, 676 N Saint Clair, Ste 650, Chicago, IL 60611. P: 312-695-4835. F: 312-695-3644. Joseph.Posluszny@nm.org Presented at the 31st Eastern Association for the Surgery of Trauma Annual Meeting, January 9-13, 2018 in Lake Buena Vista, Florida Disclosures: None Funding: This work is funded in part by the Academy for Quality and Safety Improvement (AQSI) at Northwestern University. © 2018 Lippincott Williams & Wilkins, Inc.

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