Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study

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Abstract

Background

The Clinical Frailty Scale (CFS) is a frailty assessment tool used to identify frailty in older patients visiting the emergency department (ED). However, the current understanding of how it is used and accepted in ED clinical practice is limited. This study aimed to assess the feasibility of CFS in an ED setting.

Methods

This was a prospective, mixed methods study conducted in three Swedish EDs where CFS had recently been introduced. We examined the completion rate of CFS assessments in relation to patient- and organisational factors. A survey on staff experience of using CFS was also conducted. All quantitative data were analysed descriptively, while free text comments underwent a qualitative content analysis.

Results

A total of 4235 visits were analysed, and CFS assessments were performed in 47%. The completion rate exceeded 50% for patients over the age of 80. Patients with low triage priority were assessed to a low degree (24%). There was a diurnal variation with the highest completion rates seen for arrivals between 6 and 12 a.m. (58%). The survey response rate was 48%. The respondents rated the perceived relevance and the ease of use of the CFS with a median of 5 (IQR 2) on a scale with 7 being the highest. High workload, forgetfulness and critical illness were ranked as the top three barriers to assessment. The qualitative analysis showed that CFS assessments benefit from a clear routine and a sense of apparent relevance to emergency care.

Conclusion

Most emergency staff perceived CFS as relevant and easy to use, yet far from all older ED patients were assessed. The most common barrier to assessment was high workload. Measures to facilitate use may include clarifying the purpose of the assessment with explicit follow-up actions, as well as formulating a clear routine for the assessment.

Registration

The study was registered on ClinicalTrials.gov 2021-06-18 (identifier: NCT04931472).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-023-00894-8.

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Most cited references 33

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Three approaches to qualitative content analysis.

Hsiu-Fang Hsieh, Sarah Shannon (2016)

Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.

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Frailty in elderly people

Andrew B. Clegg, John Young, Steve Iliffe … (2013)

Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.

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A global clinical measure of fitness and frailty in elderly people.

Kenneth Rockwood, Xiaowei Song, Chris MacKnight … (2005)

There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.

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Author and article information

Contributors

Erika Hörlin: erika.horlin@regionostergotland.se , KfAkutenUs@regionostergotland.se

Samia Munir Ehrlington: samia.munir.ehrlington@regionostergotland.se

Rani Toll John: rani.toll.john@regionostergotland.se

Joakim Henricson: joakim.henricson@regionostergotland.se

Daniel Wilhelms: daniel.wilhelms@regionostergotland.se

Journal

Journal ID (nlm-ta): BMC Emerg Med

Journal ID (iso-abbrev): BMC Emerg Med

Title: BMC Emergency Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-227X

Publication date (Electronic): 26 October 2023

Publication date PMC-release: 26 October 2023

Publication date Collection: 2023

Volume: 23

Electronic Location Identifier: 124

Affiliations

Department of Emergency Medicine, Department of Biomedical and Clinical Sciences, Linköping University, ( https://ror.org/05ynxx418) Linköping, Sweden

Article

Publisher ID: 894

DOI: 10.1186/s12873-023-00894-8

PMC ID: 10601295

PubMed ID: 37880591

SO-VID: ef2c1e71-450f-48b7-98f0-7e5e6e4e16ad

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 7 August 2023

Date accepted : 14 October 2023

Funding

Funded by: Linköping University

Open Access :

Open access funding provided by Linköping University.

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: clinical frailty scale,feasibility,frailty,implementation,emergency medicine,geriatric medicine,mixed methods

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: clinical frailty scale, feasibility, frailty, implementation, emergency medicine, geriatric medicine, mixed methods

Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study

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Abstract

Background

Methods

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Conclusion

Registration

Supplementary Information

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Preventive and Emergency Medicine Insights

Most cited references 33

Three approaches to qualitative content analysis.

Frailty in elderly people

A global clinical measure of fitness and frailty in elderly people.

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