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01-08-2021 | Geriatric Assessment | Original Article

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

Authors: Andrew C. Nixon, Julie Brown, Ailsa Brotherton, Mark Harrison, Judith Todd, Dawn Brannigan, Quinta Ashcroft, Beng So, Neil Pendleton, Leonard Ebah, Sandip Mitra, Ajay P. Dhaygude, Mark E. Brady

Published in: Journal of Nephrology | Issue 4/2021

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.

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Title: Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project
Authors: Andrew C. Nixon
Julie Brown
Ailsa Brotherton
Mark Harrison
Judith Todd
Dawn Brannigan
Quinta Ashcroft
Beng So
Neil Pendleton
Leonard Ebah
Sandip Mitra
Ajay P. Dhaygude
Mark E. Brady
Publication date: 01-08-2021
Publisher: Springer International Publishing
Keywords: Geriatric Assessment
Chronic Kidney Disease
Published in: Journal of Nephrology / Issue 4/2021
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-020-00878-y

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