Frailty Intervention Therapy Team (FITT): A Step in the Right Direction - Integration of Early Interdisciplinary Assessment in the Emergency Department

Introduction: Beaumont Hospital is committed to delivering on the objectives of the National Clinical Programme for Older People (NCPOP) and the Integrated Care Programme for Older Persons. The clinical needs of older people presenting to the Emergency Department (ED) are substantially different to those of younger adults. Many older people present with acute or sub-acute illnesses, which may be accompanied by functional and/or cognitive deterioration. Additionally, these patients often have complex social care needs. Evidence confirms that Emergency Department overcrowding is associated with increased mortality, increased length of stay, patient harm and reduced staff morale and therefore, hospital admissions for frail older people should be avoiding where at all possible. Prior to September, 2015, Beaumont Hospital (BH) provided an on-call Health and Social Care Professions (HSCP) service to the ED which focused only on facilitating patient discharge. The team comprised Occupational Therapy (OT), Physiotherapy (PT) and Medical Social Work (MSW). Speech & Language Therapy (SLT) was available for patients who had been admitted and were assessed in the ED. Referrals for this service were triggered by an ED doctor or Clinical Nurse Manager (CNM). However, during periods of increased patient presentations, referral rates were found to reduce significantly. This was explained by the competing pressures felt amongst ED colleagues in these times with the result that HSCP referral was not considered. At that time, there was no HSCP service based in the ED to initiate assessment for those patients deemed suitable for admission. It was in this context that BH, in late 2015, developed the Frail Intervention Therapy Team (FITT) to respond to the needs of all frail patients attending ED.Theory and Methods: The FIT Team comprises PT, OT, MSW as well as Speech and Language Therapy, Dietetics and Pharmacy. The vision for the FITT service is to foster a culture of ‘every hour counts’ for frail elderly patients and to this end, the team aims to:Identify 100% of frail patients, over the age of 75 years, who present to the ED during core hoursProvide rapid access and comprehensive multidisciplinary team (MDT) assessment to all patients identified as frailThe development of this model for service delivery was firmly underpinned by quality improvement methodology. Interactive HSCP planning workshops guided the process while the model for improvement (PDSA cycles) was key to:A)