LAUSR

BACKGROUND Older patients with frailty syndrome have a greater risk of poor post-operative outcomes. In this study, we used a RE-AIM framework to implement an assessment tool to identify frail patients and targeted interventions to improve their outcomes. STUDY DESIGN We implemented a five-question frailty assessment tool for patients ≥65 admitted to the general and vascular surgery services from 1/1/2018 to 12/31/2019. Identified frail patients received evidence-based clinical orders and nursing care-plan interventions tailored to optimize recovery. A RE-AIM framework was used to assess implementation effectiveness through provider and nurse surveys, floor audits, and chart review. RESULTS Out of 1158 patients included in this study, 696 (60.1%) were assessed for frailty. Among these, 611 patients (87.8%) scored as frail or intermediately frail. Following implementation, there were significant increases in the completion rates of frailty-specific care orders for frail patients, including delirium precautions (52.1% vs. 30.7%, p<0.001), aspiration precautions (50.0% vs. 26.9%, p<0.001), and avoidance of overnight vitals (32.5% vs. 0%). Floor audits, however, showed high variability in completion of care plan components by nursing staff. Multivariate analysis showed significant decreases in 30-day complication rates (OR 0.532, p < 0.001) following implementation. CONCLUSION A frailty assessment was able to identify elderly patients for provision of targeted, evidence-based frailty care. Despite limited uptake of the assessment by providers and completion of care plan components by nursing staff, implementation of the assessment and care interventions was associated with significant decreases in complications among elderly surgical patients.