Portiuncula University Hospital Enhancing Care for Older Persons with Frailty at the Front Door Service

Portiuncula University Hospital’s Frailty at the Front Door Service was introduced to provide a holistic assessment and intervention to patients over 75 presenting with frailty to the Emergency Department (ED).

The service is ED based and identifies and assesses patients presenting with frailty and provides individualised interventions. Many people present to the service following a fall or with changes in their ability to complete everyday tasks. Early comprehensive assessment can improve their healthcare outcomes and experience and can support their further recovery at home.

The Service commenced in September 2021 as part of the Enhanced Community Care programme (ECC) to improve and expand community health services and reduce pressure on hospital services. This year the Frailty Front Door (FFD) Team has supported discharge directly home in 55% of older people assessed by referring them to community services, in keeping with the Sláintecare vision of providing the right care, in the right place, at the right time.

The Frailty Front Door Team consists of a Clinical Nurse Specialist, Senior Occupational Therapist, Senior Physiotherapist, Geriatric Medical Registrar, Therapy Assistant and Assistant Staff Officer.

Lisa O’Looney, Senior Physiotherapist, FFD Team said, “Studies have shown that older adults are those most likely to visit a GP and to require inpatient hospital beds. For many frail older adults, a hospital stay may result in a loss of independence and a need for extra assistance on discharge.

“The FFD Team focuses on what matters to the patient and most people identify a preference for recovery at home. By completing an early assessment we aim to support this wish by referring our patients to local community supports as needed. This year so far 25% of the patients utilising the service presented to the ED after a fall. Following a holistic assessment by the team, factors contributing to falls and frailty are identified and measures are put in place to promote a safe recovery.

“Frailty is often recognised as decreased mobility, weight loss, muscle weakness and reduced energy levels. Frailty is not an inevitable part of ageing, and can be prevented, reversed or slowed down.

“The FFD Team supports older adults to live and age well by identifying drivers of frailty and by promoting physical and mental health in those at risk of becoming frail. The 2022 census reports that people are living longer and those aged over 85 are the fastest growing age group, so it is important to recognise and address the challenges faced by older people to continue to support them to remain healthy at home”, added Lisa.

Dr Laura Bandut, Emergency Medical Consultant at Portiuncula University Hospital stated, “The Frailty at the Front Door Service provides great expertise in the assessment and management of older patients presenting to ED. They ensure a multidisciplinary approach within ED environment working towards avoiding unnecessary admissions to hospital. The FFD Team is a great addition to our ED team and has significantly enhanced the quality of patient care by putting in place appropriate follow up and continuity of care for this cohort of patients in the community.”

James Keane, Hospital Manager said, “The introduction of the Frailty at the Front Door Service is part of our on-going commitment to ensure quality of care for the older person is foremost. The team ensures early multidisciplinary involvement is available at the ‘front door’ and can provide an alternative pathway to hospital admission for many.

“This specialist team provide care, treatment and support to improve the patients’ experience and help them to return home to live as independently as they can.”

Photo caption
The Frailty Front Door Team at Portiuncula University Hospital, from left, Lisa O’Looney, Senior Physiotherapist; Maria Lennon, Senior Occupational Therapist; Karen Hurley, Assistant Staff Officer; Dr Shabahat Ali, Geriatric Medical Registrar; Kelley Mc Carthy, Clinical Nurse Specialist and Stella Hannon, Therapy Assistant.