The feasibility and acceptability of frailty screening tools in the Emergency Department and the additional value of clinical judgment for frailty detection

Burgh, Rosalien van der; Wijnen, Nicky; Visscher, Mareije; Groot, Bas de; Lucke, Jacinta A.

doi:10.1097/mej.0000000000000910

Cited by 5 publications

(9 citation statements)

References 8 publications

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“…The implementation of an assessment tool in clinical practice is inevitably accompanied by challenges, particularly due to the additional workload. [14] Skills and beliefs about capacities were identi ed to be another possible barrier to implementing an assessment tool. [49] In addition, the use of an algorithm to support assessment of the CFS was shown to help with reliable scoring by untrained raters.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Frailty Scale at Presentation to the Emergency Department: Interrater Reliability and Use of Electronic Decision Support

Albrecht

Espejo

Riedel

et al. 2023

Preprint

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Purpose: The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, in order to support clinical decision making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the IRR of CFS ratings comparing assessments by ED clinicians and a study team supported by a smartphone application for CFS assessment, and to determine the proportion of patients aged 65 or older who were assigned a CFS level in our ED in routine clinical care.Methods: Prospective study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707).Results: We included 1,348 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ=0.73, 95% CI: 0.69–0.76), similarly to that between TC and geriED-TN (ϰ=0.75, 95% CI: 0.66–0.82) and between the ST and geriED-TN (ϰ=0.74, 95% CI: 0.63–0.81). A CFS rating was assigned to 972 (70.2%) patients at triage.Conclusion: We found good IRR in the assessment of frailty with the CFS in different ED providers and a team of medical students using a smartphone application to support rating. A CFS assessment occurred in more than two thirds (70.2%) of patients at triage.

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Section: Discussionmentioning

confidence: 99%

“…[11] Several assessment tools have been proposed to assist with the identi cation of frailty in the Emergency Department (ED). [11][12][13][14] The Clinical Frailty Scale (CFS) is a 9-point scale ranging from "very t" to "terminally ill". [15] It is one of the most commonly used frailty assessment tools.…”

Section: Introductionmentioning

confidence: 99%

Clinical Frailty Scale at Presentation to the Emergency Department: Interrater Reliability and Use of Electronic Decision Support

Albrecht

Espejo

Riedel

et al. 2023

Preprint

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“…As prior studies suggest that patient burden and competing priorities are barriers to ED screening, we recorded total ED volume, total encounters of patients ≥65 years, total COVID encounters, and boarding hours. [8][9][10] Boarding hours are defined as each hour a patient admitted to the hospital is waiting in the ED to move to a hospital bed. Our health system reports this starting at Hour 4 after both the admission order and the admission service are placed.…”

Section: Discussionmentioning

confidence: 99%

“…The proportion of older adults screened was analyzed using run charts of monthly data and trendlines. As prior studies suggest that patient burden and competing priorities are barriers to ED screening, we recorded total ED volume, total encounters of patients ≥65 years, total COVID encounters, and boarding hours 8–10 . Boarding hours are defined as each hour a patient admitted to the hospital is waiting in the ED to move to a hospital bed.…”

Section: Methodsmentioning

confidence: 99%

“…Interviews of ED nurses revealed that they perceived geriatric screening for delirium as a very low priority activity due to the competing demands, lack of time, and heavy workload in the ED 9 . Competing priorities is also an issue for emergency physicians and residents, who list time pressures, extra workload, and lack of routine as barriers to geriatric screening 10 . Given these known barriers, we recognized that a pragmatic, comprehensive approach would be needed to implement geriatric screening into the ED.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Southerland,

Gulker,

Van Fossen

et al. 2023

Academic Emergency Medicine

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ObjectiveImplementation of evidence‐based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real‐world use of theory‐based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening program in the ED using the Consolidated Framework for Implementation Research (CFIR).MethodsThe EBP involved nurses screening older patients for delirium (Delirium Triage Screen), fall risk (4‐Stage Balance Test), and vulnerability (Identification of Seniors at Risk score) with subsequent appropriate referrals to physicians, therapy specialists, or social workers. The proportions of screened adults ≥65 years old were tracked monthly. Outcomes are reported January 2021–December 2022. Barriers encountered were classified according to CFIR. Implementation strategies were classified according to the CFIR‐Expert Recommendations for Implementing Change (ERIC).ResultsImplementation strategies increased geriatric screening from 5% to 68%. This did not meet our prespecified goal of 80%. Change was sustained through several COVID‐19 waves. Inner setting barriers included culture and implementation climate. Initially, the ED was treated as a single inner setting, but we found different cultures and uptake between ED units, including night versus day shifts. Characteristics of individuals barriers included high levels of staff turnover in both clinical and administrative roles and very low self‐efficacy from stress and staff turnover. Initial attempts with individualized audit and feedback were not successful in improving self‐efficacy and may have caused moral injury. Adjusting feedback to a team/unit level approach with unitwide stretch goals worked better. Identifying early adopters and conducting on‐shift education increased uptake. Lessons learned regarding ED culture, implementation in interconnected health systems, and rapid cycle process improvement are reported.ConclusionsThe pandemic exacerbated barriers to implementation in the ED. Cognizance of a large ED as a sum of smaller units and using the CFIR model resulted in improvements.

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Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment

Albrecht,

Espejo,

Riedel

et al. 2023

Eur Geriatr Med

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Purpose The Clinical Frailty Scale (CFS) allows health care providers to quickly stratify older patients, to support clinical decision-making. However, few studies have evaluated the CFS interrater reliability (IRR) in Emergency Departments (EDs), and the freely available smartphone application for CFS assessment was never tested for reliability. This study aimed to evaluate the interrater reliability of the Clinical Frailty Scale (CFS) ratings between experienced and unexperienced staff (ED clinicians and a study team (ST) of medical students supported by a smartphone application to assess the CFS), and to determine the feasibility of CFS assignment in patients aged 65 or older at triage. Methods Cross-sectional study using consecutive sampling of ED patients aged 65 or older. We compared assessments by ED clinicians (Triage Clinicians (TC) and geriatric ED trained nurses (geriED-TN)) and a study team (ST) of medical students using a smartphone application for CFS scoring. The study is registered on Clinicaltrials.gov (NCT05400707). Results We included 1349 patients aged 65 and older. Quadratic-weighted kappa values for ordinal CFS levels showed a good IRR between TC and ST (ϰ = 0.73, 95% CI 0.69–0.76), similarly to that between TC and geriED-TN (ϰ = 0.75, 95% CI 0.66–0.82) and between the ST and geriED-TN (ϰ = 0.74, 95% CI 0.63–0.81). A CFS rating was assigned to 972 (70.2%) patients at triage. Conclusion We found good IRR in the assessment of frailty with the CFS in different ED providers and a team using a smartphone application to support rating. A CFS assessment occurred in more than two-thirds (70.2%) of patients at triage.

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The feasibility and acceptability of frailty screening tools in the Emergency Department and the additional value of clinical judgment for frailty detection

Cited by 5 publications

References 8 publications

Clinical Frailty Scale at Presentation to the Emergency Department: Interrater Reliability and Use of Electronic Decision Support

Clinical Frailty Scale at Presentation to the Emergency Department: Interrater Reliability and Use of Electronic Decision Support

Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research

Clinical Frailty Scale at presentation to the emergency department: interrater reliability and use of algorithm-assisted assessment

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