Feasibility and Acceptability of the Clinical Frailty Scale in a Swedish Emergency Department Setting

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the feasibility and acceptability of the Clinical Frailty Scale (CFS). The scale can potentially be adopted for daily use in the Emergency Department (ED) and have been evaluated with regard to feasibility to a certain extent, but have so far not been evaluated in the Swedish emergency care context.

Detailed Description
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The CFS is introduced and tested as part of a quality-improvement process regarding elderly people within the three Emergency departments (ED) of Region Östergötland. CFS is a 9-point scale developed within the Canadian Study of Health and Aging, a pictograph and a clinical description aids to assign scores from very fit to terminally ill. The scale enable clinicians to stratify elderly people's degree of frailty with the help of questions and clinical assessment. However, even excellent tools will not be used if they are too difficult or time consuming. The amount of papers addressing issues regarding feasibility and acceptability of the CFS in a clinical ED-setting is still limited, and for Swedish EDs non-existent. This study is part of a larger research project, data will be collected in three ways: A. All eligible patients who visit the ED for a period of six weeks will be enrolled, and subsequently assessed with CFS by one of their responsible health-care professionals (i.e. physician, registered nurse or nurse assistant). The number of screened patients divided by the total number of eligible patients will yield the screening rate. Patient- and organisational related characteristics will be collected from the electronic health record. B. 100 patients will be assessed when someone from the research team is present to enrol patients and clock the assessments. These work shifts will be selected using the online application Research Randomizer, to randomly include all hours of the day as well as eligible health-care professionals. The research-team member will document the time to complete the assessment using CFS, which will give us the screening time. C. To assess acceptability, health-care professionals will be sent a questionnaire per email, including two reminders. The questionnaire will consist of Likert scales, multiple-choice questions and open textboxes with the aim to explore facilitators and barriers for screening completion. Primary aim: To explore the feasibility and acceptability of the CFS in a Swedish Emergency care context.

Official Title
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Feasibility and Acceptability of the Clinical Frailty Scale in a Swedish Emergency Department Setting

Conditions
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Frailty

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Has been in clinical work at the ED for the period of the current study Exclusion Criteria: Unwilling to provide informed consent
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Completion rate | Proportion of completed Clinical Frailty Scale assessments in relation to the number of eligible patients | During a period of six weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duration of time to make the assessment | Measured time from that the health care professionals begins to read the instructions until he/she notes the assigned score. | The assessment will be made in connection with the patient´s first meeting with the care team, i.e. within 1 hour from the patient´s arrival to the ED | 
| Patient related characteristics correlated to completion rate | Age, gender, arrival mode, triage priority and discharge destination compared between the screened and not screened patients | From admission to discharge from the Emergency department, up to 24 hours. | 
| Organisational related characteristics correlated to completion rate | Day and time of arrival compared between the screened and not screened patients | From admission to discharge from the Emergency department, up to 24 hours | 
| Ease of use | The proportion of distributed answers to alternatives 1 (Not at all easy) to 7 (Very easy) to the question: What is your experience of how it is to decide what CFS score a person has ? | Questionnaire that can be answered within five weeks | 
| Relevance | The proportion of distributed answers to alternatives 1 (Completely irrelevant) to 7 (Very relevant) to the question: How relevant or irrelevant do you experience that it is to use CFS in the emergency department? | Questionnaire that can be answered within five weeks | 
| Facilitators to perform assessment | Health care professionals descriptions of what facititates performance of frailty assessments, qualitative analysis of the respondents' written answers in a free text box  | Questionnaire that can be answered within five weeks | 
| Barriers to perform | The proportion of distributed answers to existing alternatives, and qualitative analysis of the respondents' written answers in the free text box other reason. | Questionnaire that can be answered within five weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Frailty, Geriatric assessment, Emergency service, Feasibility studies, Geriatric emergency medicine