Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality impro
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ORIGINAL ARTICLE
Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project Andrew C. Nixon1,2,3 · Julie Brown4 · Ailsa Brotherton5 · Mark Harrison4 · Judith Todd1 · Dawn Brannigan1 · Quinta Ashcroft6 · Beng So1 · Neil Pendleton7 · Leonard Ebah8 · Sandip Mitra8,9,10 · Ajay P. Dhaygude1 · Mark E. Brady1 Received: 21 July 2020 / Accepted: 23 September 2020 © The Author(s) 2020
Abstract Introduction The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD. Methods A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan. Results A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20–1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63–2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems. Conclusions This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients. Keywords Aging · Chronic kidney disease · Elderly · End stage renal disease · Hemodialysis
Introduction One of the greatest challenges for healthcare in the twentyfirst century is population ageing [1]. With population ageing comes an increasing prevalence of individuals living with multimorbidity and associated frailty, the state Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00878-y) contains supplementary material, which is available to authorized users. * Andrew C. Nixon [email protected] Extended author information available on the last page of the article
of vulnerability to disproportionate deterioration in health status when exposed to stressor events [2, 3]. This is relevant for all areas of healthcare, but it is especially so for specialised services, such as nephrology, that care for people liv
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