IMPLEMENTATION OF A RISK ANALYSIS INDEX-BASED PREOPERATIVE FRAILTY SCREENING AND MANAGEMENT PROGRAM

Frailty reduces recovery from stressors like surgery and increases postoperative morbidity and mortality. Risk Analysis Index (RAI-C) is a validated pre-surgical frailty assessment tool, however the agreement between provider-completed and patient-completed RAI is unknown. We explored the consistency and accuracy of provider-based screening and the agreement between provider-completed and patient-completed RAI-C scores. Orthopedic providers completed the RAI-C on Veterans ≥65 years of age awaiting elective total joint arthroplasty and referred patients to rehabilitative, nutritional, or geriatric specialty services based on RAI-C score. Patients were mailed the same RAI-C form to complete independently. Process measures reviewed the screening frequency and accuracy of using the referral pathway. Agreement between provider-completed and patient-completed total RAI-C score and differences within individual domains were compared. Overall, RAI screening occurred in 48% of eligible patients. Providers were less accurate in their referral of frail (RAI-C 30-36) patients than those who were robust or very frail. Screening frequency improved with dedicated nursing champions reminding providers to screen. The correlation between patient-completed and provider-completed RAI-C was moderate (r=0.634; p