(P66) Frailty Monitoring in Skilled Nursing Patients and Associated Outcomes

Introduction/

Objective: Frailty is a common problem in the post-acute and long-term care setting. Frail patients are known to have an increased risk for poor health outcomes, including falls and hospital readmission. However, measurement and treatment of frailty in this setting is often overlooked. The goal of this study was to measure frailty in patients admitted for skilled care at a single facility over a 6-month period, and then use that data to implement health care changes and drive goals of care conversations.

Design/Methodology: Beginning in September 2022, patients admitted to a 139-bed skilled nursing facility in Pittsburgh, PA were followed. A 30-item frailty index (FI) was implemented into the facility EHR. The RNAC nurses in the facility were part of the beta testing project and felt comfortable proceeding forward with completion of the FI during MDS processing. Frail patient scores were analyzed for areas where improvements could be made, and the appropriate consults were made. Patients were followed forward to determine disposition and guide goals of care conversations.

Results: As of December 2022, 36 patients have been screened on admission to skilled nursing. The average frailty index score is 0.35 with a range of 0.07-0.60. The most common deficits were disability in transferring (30), bathing (32), toileting (31), and dressing (30). Of the patients evaluated, 10 returned home, 13 had an escalation in their level of care, and 6 died. The average frailty index score was 0.37 in the death group, 0.38 in the escalation of care group, and 0.27 in the home discharge group. There was no statistical significant difference between these groups in this current sample size.

Conclusion/

Discussion: Frail patients regularly enter skilled nursing facilities, but treatment and outcomes for these patients is poorly studied. In this study patients entering skilled nursing were evaluated using a 30-item frailty index. The most common deficits on a frailty index were disability in ADL's, which can be correctable factors with skilled therapy. There was a difference in the frailty index when examining the outcome, but it was not statistically significant. Part of this is due to the small sample size currently and this will continue to be evaluated as further patients are screened. However, the difference in score suggests that frailty score could be used to help drive goals of care and level of care discussions. Some limitations in this study include the small sample size and lack of discharge frailty scores, which we are working on improving at this time.