• J. Am. Coll. Surg. · Dec 2021

    Implementation of a Frailty Assessment and Targeted Care Interventions and Association with Reduced Postoperative Complications in Elderly Surgical Patients.

    • Spencer Wilson, Evan Sutherland, Alina Razak, Mollie O'Brien, Callie Ding, Thien Nguyen, Pam Rosenkranz, and Sabrina E Sanchez.
    • Department of Surgery, Boston Medical Center, Boston, MA. Electronic address: spencer.wilson@bmc.org.
    • J. Am. Coll. Surg. 2021 Dec 1; 233 (6): 764-775.e1.

    BackgroundOlder patients with frailty syndrome have a greater risk of poor postoperative outcomes. In this study, we used a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes.Study DesignWe implemented a 5-question frailty assessment tool for patients 65 years and older admitted to the general and vascular surgery services from January 1, 2018 to December 31, 2019. Identified frail patients received evidence-based clinical orders and nursing care plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review.ResultsOf 1,158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. After implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs 30.7%; p < 0.001), aspiration precautions (50.0% vs 26.9%; p < 0.001), and avoidance of overnight vitals (32.5% vs 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (odds ratio 0.532; p < 0.001) after implementation.ConclusionsA frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with substantial decreases in complications among elderly surgical patients.Copyright © 2021 American College of Surgeons. All rights reserved.

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