Prescriber Documentation

For acute care inpatients, frailty screening should be completed ideally within 72 hours of admission. There are several places where prescribers can screen for and document a patient's level of frailty:

• Navigators

  • General admission navigator - Transition planning section

  • Critical Care admission navigator (for intensivists)

• Patient Lists

  • Clinical Frail Scale patient list column

  • Rapid Rounds (multidisciplinary planning) patient list template

  • Transition Planning patient list report

• Sidebar

  • Transition Plan section of prescriber, nursing, allied health and other inpatient chart sidebars

  • Scores and Scales section of inpatient chart sidebar

Team Documentation

The 72 hour window allows consultation to and documentation by non-prescribers. Nursing and allied-health users can document the Clinical Frailty Scale in the following activities:

• Patient Lists

  • Rapid Rounds report

  • Clinical Frailty Scale patient list column

• Sidebar

  • Transition Plan section

• Flowsheet

  • Clinical Frailty Scale

Edmonton Frailty Scale (Acute Care and Continuing Care versions) can be accessed and used from within sidebar and flowsheet activities.

Frailty Screening Documentation

The metric evaluates values stored in the following flowsheet rows:

• Clinical Frailty Scale score (FSD 1000 = 10306)

• Edmonton Frail Scale (Acute Care) score (FSD 1000 = 210770348)

• Edmonton Frail Scale (Continuing Care) score (FSD 1000 = 22361)

Frailty Screening

Description

• Proportion of older adults (65+) with frailty screening completed within 72 hours of admission.

Denominator

• Number of Patient Encounters where:

  • ADT Patient Class (EPT 10110) = Inpatient [101] AND

  • Patient Status (EPT 10115) = Admission [2] OR Discharged [3] AND

  • Level of Care (EPT 10135) = Acute [1] AND

  • Age at Encounter (EPT 120) >= 65 AND

  • Admission Effective Instant (EPT 10290 10291) = User specified date of admission

  • Observation occurs between admission instant (ADT 59) and discharge instant (EPT 18855 and EPT 18856)

Note 1: Patients whose admitting unit (ADT 50) is Emergency Department type, with status of emergency inpatient (EIP) are included in the denominator under ED unit where the documentation took place. 

Note 2: Patients who have been admitted for less than 24 hours are not included in the metric, but added back when 24 hours has passed. This impacts reporting period of yesterday, but negligible for other periods. 

Numerator

• Number of Patient Encounters in the denominator where:

  • Flowsheet row instant (I FSD 1000) MINUS the Date and Time When First Inpatient (EPT 10290 10291)* IS LESS THAN OR EQUAL 72 hours

Flowsheet rows evaluated:

• Clinical Frailty Scale score (FSD 1000 = 10306) OR

• Edmonton Frail Scale (Acute Care) score (FSD 1000 = 210770348) OR

• Edmonton Frail Scale (Bedside) score (FSD 1000 = 22361) 

Note: The time when patient first became inpatient is triggered when the admit order is released.

Calculation

• Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point

Filters

• Hospital Specialty Service: ADT 70 - CATEGORY - (e.g., General Internal Medicine [106])

• Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])

• Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])

Note: Hospital Unit is defined as the patient encounter department where the flowsheet row was first documented. If documentation does not exist, it’s defined as the current encounter department for admitted patients (EPT 18880), and last encounter department for discharged patients (EPT 18880).

Analytics Definition

• Crib-Sheet: Frailty Screening Metric Definition

Timeliness

Frailty Screening metrics are currently used for admitted or discharged patients and are retrospective (assessment may be delayed by several hours for admitted patients). They are intended to reflect patients' baseline (convalescent, prior to any acute intercurrent illness) status and so do not necessarily help with needs or resource determinations keyed to a patient's current status. The metrics can help teams set goals for behavior (meaningful use) and process changes but cannot be used for real-time observation of behavior change. For real-time monitoring, staff and managers can review the Rapid Rounds fraily column and transition planning report.

Radar Dashboards

Reporting Workbench

Slicer-Dicer