hello my name is dr sunny jockler and i'm one of the emergency medicine registrars currently working at the leicester oil infirmary emergency department welcome to the first part of a series of faulty based teaching sessions this session is about how to perform a clinical faulty score in the ed which can be used to plan and tailor interventions for our patients this is the beginning of a series of teaching materials that will be made available over the next six months here i will be introducing you to the clinical faculty school what is the clinical further score and how do you apply this to our patient population but more importantly how do i approach a patient who is frail but please note this is not the whole picture this is a complex group of patients that are not always easy to assess in our challenging environments in the next few slides i'll be presenting some guiding principles that will help you when managing these patients within our clinical setting at the leicester oil infirmary approximately two-thirds of patients presenting to the emergency department are older and frail this is our everyday bread and butter they can present with any of the geriatric syndromes listed in the slide you can scan the available qr code that will take you to some further teaching resources about these syndromes so here is the clinical fraternity score that can be undertaken by any appropriately trained healthcare professional this score directly correlates with adverse outcomes that is the higher the cfs the higher the associated morbidity and mortality a few things to remember don't let the pictures misguide you please refer to the descriptors so to help you with this please follow the qr code on the right hand side to download the clinical authority app to your phone secondly do not use a cfs in isolation but instead be mindful of how it provides context to the patient that you are seeing please ensure that you ask the patient or next of kin or paramedics etc of what the patient's capability was two weeks ago not right now be careful about differentiating between cfs six and seven cfs6 is when a patient needs help with outdoor activities and some help with basic activities whereas a cfs of 7 is when a patient is dependent for all forms of personal care including hygiene and toileting all cause mortality during admission to acute hospital is about six percent of the cfs of six however if you're a cfs of seven it can go up to eleven percent so therefore please use the app to correctly score your patients putting this all together in a stepwise approach so step one is the patient frail if the answer is no focus on the problem at hand just as you would with any patient if the answer is yes what is the cfs use the app to help you accurately grade this bearing in mind this is giving you context to what your patient was like two weeks ago what does the patient want that is what is their wishes or special requests for example some patients would want to be treated at home where possible third step it is important that we aim to make sure decisions for these patients so please involve family next of kin and care homes where possible finally what are we trying to achieve for some patients comfort will be the priority have we made a conscious decision not to do anything in the best interest of the patient you are an important part of the patient's journey you can make a difference where possible involve your patient in the management plan and when this is not possible be sure to communicate with family next of kin and care homes etc you are not alone and you will not be making decisions in isolation discuss cases with seniors and other specialties and the more you see the more you will learn take the opportunity to learn from this fascinating group of patients every shift i find out something new and i'm always grateful for the amazing stories they share with me sometimes less is more and that is okay especially if it's the right thing for that patient at that point in time thank you for joining me for our first part of the friday teaching series to find out more about frailty as a concept please follow the qr code and links on the next two slides for any further information or queries please contact a member of the ed education team