Development of a hospital palliative service line based on needs assessment utilizing the clinical frailty scale (CFS)

Background The palliative care service is an essential element of patient care within the hospital setting Palliative care consultation leads to improved patient satisfaction and quality of life, while being cost effective through reduction in length of stay and readmission rate Frailty syndrome is a physiological process involving declining function, organ system failure, and decreasing adaptability to stress The CFS is a validated screening tool utilized by various specialties in correlating hospital outcomes, surgical readmission rate, prediction of unplanned hospitalization, disease prognostication, and risk of death [1] To determine palliative care needs, the Geriatric department of a small community hospital in rural Western North Carolina performed a needs assessment utilizing the CFS Methods CFS scores were calculated on all patients 60 and older admitted to the hospital over a 30-day period by reviewing nursing intake, case management and physical therapy documentations A score of 7-9 (severely frail) indicated a need for palliative care consult A score of 6 (moderately frail) indicated a need for possible palliative care consult due to disease burden and high risk for readmission (15%) Results CFS scores were calculated for 204 patients COVID-19 patients (n=24) were excluded due to unpredictable outcomes and length of stay The average patient age was 74 86 years (SD 9 41) 20% (n=41, 95% CI 14 6-25 6%) of the patients had a score between 7-9, and of those the average hospital length of stay was 4 97 days (SD 4 15), as compared to the rest of the population, 4 10 days (SD 3 80) 23% (n=47, 95% CI 17 5-29 4%) of the patients had a score of 6 Conclusion Assessment of frailty by utilizing the CFS in hospitalized patients demonstrated a need for palliative care consultation in a small community hospital Data on CFS and length of stay afforded the implementation of a pilot palliative care consult service to promote service utilization Of note, patients with CFS score of 6 may benefit from inpatient geriatric consultation due to disease burden (Table Presented)