Metrics Definition - Frailty Screening
Frailty Screening
Individuals living with frailty are at a higher risk for negative health outcomes and death. The central feature is increased vulnerability with reduced physical reserve and loss of function across multiple body systems. In acute care settings, case finding for frailty should be considered in any individual over 65 or with a pattern of age-related decline. Age-related decline is a change in overall health status characterized by common problems in older age, such as falls, immobility, cognitive impairment, unintentional weight loss, multi-morbidity and polypharmacy. See Provincial Clinical Knowledge Topic on Frailty, Seniors - Acute Care.
Workflow
Prescriber Documentation
For acute inpatients, frailty screening should be completed ideally within 72 hours of admission. There are several places where prescribers can document the Clinical Frailty Scale:
Sidebar
Discharge Planning
Scores and Scales
Navigator
Scores and Scales
Admission to Critical Care (only for intensivists)
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
Estimating Expected Dates pop-up window from the Multidisciplinary Discharge/Transfer Readiness SmartForm
Flowsheet
Clinical Frailty Scale
Edmonton Frailty Scale (Acute Care and Bedside versions) can be documented within the flowsheet activity.
Data
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 (Bedside) score (FSD 1000 = 22361)
Metrics
Frailty Screening
Description
Proportion of older adults (65+) with frailty screening completed upon 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 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
Limitations
Timeliness
Frailty Screening metric is currently calculated for admitted or discharged patients, is retrospective (or delayed by several hours for admitted patients), and so does not necessarily help with current status of required organizational practice. The metric 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 report in the patient list.