Preoperative Anesthesia Assessment of Frailty in the Southern Arizona Older Adult Population

Abstract

Purpose. The purpose of this project was to assess the perceived baseline knowledge of anesthesia providers on frailty in older adults and educate them about the modified frailty index-5 (mFI-5) scoring tool. The aim was to increase knowledge about frailty so anesthesia providers can recognize those at risk for more perioperative complications and how these predictors can tailor anesthetic management resulting in improved patient outcomes. Background. Frailty is defined by a person’s lack of physiological reserves, most often prominent in the older adult population. Research suggests that preoperative frailty can result in postoperative complications, prolonged length of hospital stay, and 30-day readmission rates compared to the non-frail population. An evidence-based frailty scoring tool such as the mFI-5 can identify those at risk and can be quickly incorporated into a provider's preoperative assessment by identifying those at risk and tailoring an anesthetic plan to minimize complications. Methods. This quality improvement process implemented the Plan-Do-Act-Study method which incorporated Kurt Lewin’s Change Theory ideologies to aid in the change process. The intervention was an evidence-based educational presentation with a post/pre-survey of three demographic questions followed by six questions that use a Likert-Scale rating system. A 30-day post-education survey assessed practice change, benefit of the intervention and comfort and confidence in assessing frailty. Results. Participants (n=6) attended the educational presentation, all of whom were CRNAs. Prior to the educational presentation, 100% of participants did not use an evidence-based frailty scoring tool to assess their patients preoperatively. Following the intervention, 100% of participants reported that they were extremely likely to implement a scoring tool into their evaluation. The results of the 30-day follow-up survey showed that 83% of participants had modified their practice to incorporate the mFI-5 into their preoperative routine. Conclusions. Participants reported increased knowledge surrounding frailty and a clear intent to modify their practice to incorporate a frailty scoring tool. The follow-up survey showed that the quality improvement project successfully had an impact on the practice of these providers, with the majority reporting that they had made changes to their practice.