30MEASURING THE PROCESS OF CARE OF FRAIL OLDER PATIENTS IN HOSPITAL: THE FRAIL OLDER PATIENT ADMISSION QUESTIONNAIRE (FOPAQ)

Frail older people admitted to hospital are at greater risk of adverse outcomes and prolonged length of stay. We suspected significant variations in care for this vulnerable patient group at Royal Blackburn Hospital (RBH), particularly on non-specialist wards. We therefore designed a structured questionnaire (FOPAQ) specifically for frail older hospital inpatients, addressing the process of care across the medical division. The questionnaire was developed iteratively by a multidisciplinary team skilled in the management of frail older patients. The final draft was piloted on 5 inpatients to demonstrate face validity. Patients were identified using the following criteria: age > 80 with any of; falls, reduced mobility, delirium/dementia, care home resident or admission from intermediate care. Case notes were interrogated using the questionnaires, which were completed by paired members of the frailty MDT (geriatrician, ward manager, therapist and social worker). 50 hospital inpatients were surveyed across the medical division. 26% of patients were admitted without any apparent identifiable new medical need. 37% of patients were transferred to a ward between hours of midnight and 6am, and 26% had one or more ward transfers. There was evidence of hospital related harm in 25% of cases. Disappointingly; only 38% had evidence of comprehensive geriatric assessment (CGA), despite 28% having specialist old age mental health needs. Clinical condition fluctuated unpredictably in 42% of cases. Only 30% were felt likely to be discharged to current level of care, with 80% requiring complex discharge team input. The MDT felt that 50% of patients were likely to be in the last year of their life. FOPAQ has highlighted multiple potential areas for improvement in the care of frail older hospital inpatients in this acute trust. The questionnaire was easy to use, and could easily used by other trusts. We feel it has accurately identified areas of poor practice in the care of frail older people and informed potential service improvement. As a result of our findings, and other related work; the pathway of care for frail older people in acute and community settings is to be re-designed; with measures including acute frailty assessment in MAU; integrated discharge team and intensive home support service; and better access to CGA and closer working with palliative care teams either planned or already implemented.