Early Integration of Palliative Care in Frail Patients with Hip Fracture

Frailty is a condition of vulnerability characterized by instability and inconsistency after a stressor event. It is associated with a range of adverse outcomes including delirium, falls, disability, mortality, and increased healthcare utilization. A subset of frail patients who are increasingly high risk for poor outcomes are older adults with hip fracture. Palliative care is a philosophy of care focused on maximizing the quality of life for seriously ill patients and their families. For frail patients with hip fracture, timely referrals to palliative care are essential to have a meaningful impact on quality of life. Recommendations for frailty screening have been offered by professional organizations; however, multiple barriers to routine preoperative frailty assessment exist. This quality improvement project evaluated the feasibility of utilizing a frailty screening tool on patients (age > 65) with hip fracture to readily identify patients with palliative care needs at the time of admission. Although nurses' compliance with the screening tool was less than expected, having a standardized process to accurately identify this high risk population resulted in a higher percentage of appropriate palliative care referrals when compared to usual practice. Improvement in quality of life was reported in patients who received a palliative care consultation.