The Frailty at the Front Door Service (FFD ) in Galway University Hospitals commenced in 2021 and since then over 2,200 older patients have benefitted from targeted assessment and interventions to help them remain well at home.
The FFD service is a team of physiotherapists, clinical nurse specialists, occupational therapists and geriatricians who work with patients over the age of 75 who present to the Emergency Department with frailty; this usually arises after a fall or because of changes in a patient’s ability to complete everyday tasks.
The service uses a holistic and multi-disciplinary approach to help frail patients to avoid a hospital stay by intervening at the earliest point in the patient’s journey, that is, at the front door in the Emergency Department.
Many older patients express a preference to recover from a health set back in their own home and a large part of the FDD service involves supporting the patient with a safety net of clinical services when they are discharged from the Emergency Department.
We are seeing a large increase in the number of older patients attending hospitals, particularly among patients aged 75 and older, which has increased by almost 21% compared to the same period in 2019. It is crucial that older patients have alterative pathways to appropriate care outside of the acute hospital system, and this is what FDD strives to achieve.
Kathleen O’Sullivan from Galway was referred to the Frailty team recently after she became unwell, and her son Ultan describes the service as a hugely positive experience.
“The FDD team showed unbelievable compassion, respect, patience and understanding to my Mum and her needs. Prior to Mum arriving home from hospital, the Frailty therapists came to her home to assess the space and to see what equipment would be required to allow her recover from her set back,” he said.
Ultan has praised the Frailty team for their efficiency and professionalism but more importantly for fully consulting with him as Kathleen’s main carer.
“During my Mum’s recovery, the team made several visits to her home to monitor her progress, to give support and advice. In addition, they reached out to other local community services such as PHN, Home Help and Physio Services.
“As a direct result of the Frailty Team’s interventions, together with the other great local health services, Mum has made a full recovery and regained her independence to continue to live with dignity in her own home.”
Some of the key aspects of the FDD service are continuity of care and follow up, this year the Frailty team has supported discharge directly to home in over 60% of frailty cases presenting to the Emergency Department. This involves working with colleagues in Galway’s Integrated Care Programme for Older Persons to ensure that patients can safely recover at home with access to the appropriate clinical specialists should they need it.
Orla Sheil is Senior Occupational Therapist in the FDD service, and she described some of the work carried out by the team.
“Early assessment means we find out what’s important to our patients and what their needs are and early intervention means we find ways to support their safe recovery at home. This approach has really significant outcomes both in terms of patient flow in the hospital setting leading to shorter length of stay and also enhances mobility, recovery and independence for our frailty patients.
“Some of the interventions we carry out include; a review of medications; addressing incontinence issues; assessing mobility; providing exercise and activity programmes; recommending necessary equipment to maintain independence at home and linking patients with resources in their own community to better manage their own health.”
Dr Cliona Small, Consultant Geriatrician said that the Frailty at the Front Door service here in Galway is in constant evolution.
“We are continually developing and expanding the service to meet increasing demands. Our overall goal is to prevent hospital-acquired disability by reducing hospital stays for frail patients and facilitating a safe discharge home with appropriate follow-up.
“It’s important to note that this service is only one component of a patient’s journey with the healthcare system and we work closely with community care teams and our integrated care colleagues to provide optimal care to our older patients,” she added.
The Frailty service is part of the Enhanced Community Care programme (ECC ) to improve and expand community health services and reduce pressure on hospital services. The National Integrated Care Programme for Older Persons aims to develop primary, secondary and acute care services for older people with a specific focus on those with more complex needs and frailty.