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Summary
It is estimated that more than a quarter of older adults are frail, making them more likely to have poor health outcomes. With an ageing population, itimely recognition of frailty followed by an evidence-based intervention can improve health outcomes.
We partnered with five health services to introduce an approach to frailty screening and management - recognising and providing timely intervention to patients presenting with frailty and pre-frailty.
Outcome
We tested a frailty screening process and bundle of care to address frailty in five community settings, with a targeted response addressing strength, nutrition and polypharmacy.
Health services reported an 18 per cent increase in screening, and older people reported improvements in function, social interaction, independence and enjoyment.
Targets
- The percentage of older people screened for frailty increased from 70 to 88%
- No significant improvement was observed in percentage referred to the bundle of care
- There was a trend towards slight improvement in frailty status (note: limited data)
- Consumer reported benefits including improvement in function, social interaction, increased independence, enjoyment and being pushed out of comfort zone
- Increased clinician knowledge and understanding of improvement science.
Project summary
- Cardiac, renal and stroke
- Chronic disease
- Consumer engagement and support
-
Emergency and critical care
- Delirium Evaluation in the Timely delivery of Emergency Care Trial (DETECT)
- Artificial intelligence in cardiac arrest (AIDE)
- Acute coronary syndrome project
- Establishing the Victorian ECMO service
- Gippsland region telehealth
- Sepsis bundle of care
- Improving emergency access collaborative
- Lower complexity urgent care
- Standardising inotropes and vasopressors
- Supporting statewide Medical Emergency Team/rapid response
- Medications, treatment and infection prevention
- Mental health and wellbeing
-
Mothers, babies and children
- Assessment and care of the jaundiced newborn at home
- Better births for women collaborative
- Closing the gap on maternal immunisation
- Developing ambulatory care services for women in Peninsula Health
- Expanding our Maternity and Neonatal eHandbooks
- Improving the management of paediatric sepsis
- Medical management of miscarriage at home
- Obstetric triage decision aid
- Perineal protection project - audit tool
- Postpartum Haemorrhage Collaborative
- Reducing clinical variation in paediatric adenotonsillectomy
- Reducing preventable stillbirths in Victoria
- Reducing unnecessary prescribing in infant reflux
- Safer baby
- Sharing service data through a maternity dashboard
- Reducing paediatric outpatient and emergency department referrals
- Strengthening safety oversight
-
Older people and palliative care
- Families And Carers as part of healthcare Teams (FACT) Pilot Project
- Advance care plans across the health system in rural Victoria
- Creating Age-Friendly Health Systems in Victoria
- Falls review tool: Pilot project
- Building an age-friendly Indigo health system
- Collaborative model for a falls response service
- Delirium collaborative
- Early intervention palliative and supportive care clinic
- End PJ paralysis: Preventing functional decline in inpatients
- Frailty recognition and response in the community
- Geri-Connect
- Geri-Connect scaling project
- Guiding the safe use of bed rails
- Hospitals and patients working in unity (HOW-R-U?)
- Informing best practice for managing patients with hip fractures
- Preventing delirium
- RAPID Assist
- We are Ambulance Victoria Engaged (WAVE)
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Patient flow, outpatient care and telehealth
- Bendigo Cancer Centre survivorship service
- Telehealth for people with young onset dementia (BRIGHT-YOD)
- Critical care telehealth
- Critical care telehealth scaling project
- Improving after hours care at Monash
- North east robotics development
- Outpatient demand management strategy
- Rapid access musculoskeletal care
- Remote drug and alcohol recovery for the Southern Otways region
- Low-risk fever and neutropenia program
- Using big data modelling to improve access to outpatient clinics
- Virtual fracture clinics
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