This increase is mainly due to the arrival of more frail patients over the age of 75 and reflects Plató’s growing role as a reference centre for frailty care within the Barcelona Esquerra Integrated Health Area (AISBE). The department is part of the Emergency Department at Clínic Barcelona, headed by Dr Miquel Sánchez.
This change has been made possible by reorganising patient care pathways in collaboration with the Emergency Medical Services (SEM) and Primary Care. At the same time, the dual triage model has been consolidated, systematically incorporating the Clinical Frailty Scale (CFS) to assess patients’ degree of frailty and prioritise care according to their individual needs. Medical assessments also include a situational diagnosis and an individualised treatment plan, with the involvement of the entire healthcare team.
This model makes it possible to adapt care to each person’s needs and minimise the impact of their stay in the Emergency Department, as well as the risk of associated geriatric syndromes such as immobility and delirium. Despite the increase in activity and the complexity of the cases treated, fewer than 25% of frail patients require hospital admission. This outcome is based on directing each patient to the most appropriate care resource, whether hospital-at-home care (HDOM), intermediate care or discharge home with coordinated follow-up through Primary Care.
Improving frailty care
The project, conceived from the outset as a cross-disciplinary initiative to improve frailty care, has been developed thanks to functional facilities adapted to the needs of these patients and, above all, to the commitment and training of nursing staff, nursing assistants, healthcare support staff, administrative staff and doctors. However, the increase in activity and clinical complexity highlights the need to strengthen the specific resources available in this area.
“One year on, we can look back very positively on the consolidation of this frailty care model. The increase in activity and patient complexity confirms the importance of this department and of coordinated work with local healthcare services. We want to continue moving towards more comprehensive care that is better adapted to the needs of older people, but we cannot achieve this simply by reorganising the Emergency Department. We need resources and social integration, a bioethical debate on the appropriateness of therapeutic interventions, and the active involvement of patients and their families in decision-making. Only then will organisational improvements be sustainable,” says Dr Sira Aguiló, head of the Emergency Department at the Plató site.
One year after its launch, Plató Emergency Department continues working to consolidate and expand this model, which prioritises comprehensive assessment, continuity of care and the use of the most appropriate care resource in each case, while maintaining the quality of care for a population that is increasingly older, frailer and clinically complex.
