Improved LOS and 30 Day Readmissions in Frail Surgery Patients

Introduction: Frail geriatric trauma and emergency general surgery (TEGS) patients have higher rates of complications, longer lengths of stay (LOS) and readmission rates when compared to non-frail TEGS geriatric patients. Although these outcomes are worse, little has been done to shorten LOS and decrease readmission rates for frail patients. In order to improve these outcomes, all geriatric TEGS patients were screened for frailty using the TEGS Specific Frailty Index and then, if frail, these patients were started on a frailty pathway of care. With frailty screening and the frailty pathway, our goal was to reduce LOS and 30-day readmission rates for frail geriatric TEGS patients. Methods: All geriatric TEGS patients were screened for frailty with the TEGS Specific Frailty Index at the time of admission. Frail patients received targeted interventions including use of a specialized admission orderset, input from a hospitalist consult, expedited social work, physical therapy and occupational therapy assessment, palliative care consultation when appropriate and early family engagement to establish discharge disposition and predicted LOS. At discharge, patients were scheduled to see either our service or their PCP within 7 days. Pre-intervention LOS and readmission rates were obtained for frail and non-frail TEGS geriatric patients for 2 months prior to implementing the frailty pathway. The post-intervention period included both frailty screening and the use of the frailty pathway. Results: All (100%) geriatric patients were screened for frailty. Fifty-two patients were screened in the pre-intervention period, and 12 (22.6%) of these patients were frail. Frail patients had longer average LOS (15.5 ± 18.4 days, frail v. 5.7 ± 3.5, non-frail) and higher readmission rates (36.4% v. 10.5%). In the post-intervention period, 45 patients were screened of which 14 (31%) were frail. With the frailty pathway, average LOS for frail patients decreased to 9.7 ± 9.6 days from 15.5 (5.8 day decrease), and 30 day readmission rate decreased to 29.0% from 36.4% (7.4% decrease). Conclusions: Screening for frailty and then implementing a frailty pathway decreased LOS and 30 day readmission rates for frail geriatric TEGS patients. With increased sample sizes, we anticipate enough data to demonstrate statistical significance. Given these positive findings, we plan to work on developing the resources to make frailty screening and implementation of the frailty pathway a sustained resource for not only TEGS patients but any frail geriatric patient admitted to the hospital.