Evidence map›Paper›PMID 36454710›Full record

ArticleBMJ open quality2022

Development and assessment of an educational intervention to improve the recognition of frailty on an acute care respiratory ward.

Aaron Leblanc, Nermin Diab, Chantal Backman, Shirley Huang, Tammy Pulfer, Melanie Chin, Daniel M Kobewka, Daniel I McIsaac, Julie Lawson, Alan J Forster and 1 more

Abstract read
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In one paragraph

Article in BMJ open quality, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Aaron LeblancDepartment of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Nermin DiabDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.
Chantal BackmanSchool of Nursing, University of Ottawa, Ottawa, Ontario, Canada.
Shirley HuangDivision of Geriatric Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Tammy PulferThe Ottawa Hospital, Ottawa, Ontario, Canada.
Melanie ChinDivision of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Daniel M KobewkaClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Daniel I McIsaacClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Julie LawsonClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Alan J ForsterClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Sunita MulpuruDivision of Respirology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada smulpuru@toh.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFrailty is a robust predictor of poor outcomes among patients with chronic obstructive pulmonary disease yet is not measured in routine practice. We determined barriers and facilitators to measuring frailty in a hospital setting, designed and implemented a frailty-focused education intervention, and measured accuracy of frailty screening before and after education.

methodsWe conducted a pilot cross-sectional mixed-methods study on an inpatient respiratory ward over 6 months. We recruited registered nurses (RNs) with experience using the Clinical Frailty Scale (CFS). RNs evaluated 10 clinical vignettes and assigned a frailty score using the CFS. A structured frailty-focused education intervention was delivered to small groups. RNs reassigned frailty scores to vignettes 1 week after education. Outcomes included barriers and facilitators to assessing frailty in hospital, and percent agreement of CFS scores between RNs and a gold standard (determined by geriatricians) before and after education.

resultsAmong 26 RNs, the median (IQR) duration of experience using the CFS was 1.5 (1-4) months. Barriers to assessing frailty included the lack of clinical directives to measure frailty and large acute workloads. Having collateral history from family members was the strongest perceived facilitator for frailty assessment. The median (IQR) percent agreement with the gold-standard frailty score across all cases was 55.8% (47.2%-60.6%) prior to the educational intervention, and 57.2% (44.1%-70.2%) afterwards. The largest increase in agreement occurred in the 'mildly frail' category, 65.4%-81% agreement.

conclusionsBarriers to assessing frailty in the hospital setting are external to the measurement tool itself. Accuracy of frailty assessment among acute care RNs was low, and frailty-focused rater training may improve accuracy. Subsequent work should focus on health system approaches to empower health providers to assess frailty, and on testing the effectiveness of frailty-focused education in large real-world settings.

Indexed as

FrailtyCritical CareCross-Sectional StudiesHospitalsHumansChronic disease managementHealth professions educationHospital medicine

Identifiers

PMID36454710
PMCPMC9362820

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.