1949 Improving the utilisation rate of ‘hot slots’ in an outpatient frailty service

Abstract Background North Middlesex University Hospital runs an outpatient frailty service where patients are referred for a Comprehensive Geriatric Assessment. There is a daily ‘hot slot’ for patients who otherwise would have required hospital admission if not seen within seven days. We aimed to improve utilisation of hot slots from 50% to 100%. Empty hot slots result in the under-utilisation of pre-allocated resources and increase the workload of healthcare professionals in other departments. Methods Author ESK audited hot slot usage in November and December 2022, marking slots as ‘filled’ or ‘unfilled’. In January 2023 we established a clear referral process for the hot slots and implemented an education program targeted at referrers to increase awareness of the availability of hot slots and referral criteria. Authors ESK, NS and FM re-audited the hot slot usage from February to April 2023. Author FM analysed the data and conducted statistical testing of the results. Authors NS and FM produced visual representation of the data collected. Results After exclusion of periods where the hot slots were closed (n=13) including strike days, bank holidays and times with below minimum staffing; 82 hot slots were audited, pre-intervention (n=39) and post-intervention (n=43). The utilisation of hot slots increased from 51% pre-intervention to 86% post-intervention. Fisher's exact test shows this is statistically significant (p<0.0007). Conclusions The education program increased utilisation of hot slots but fell short of the targeted 100% utilisation rate. We made the hot slot available exclusively to the Geriatric Emergency Medicine (GEM) team for one week in August 2023 to assess whether this increases GEM utilisation of the hot slot. We intend to further analyse the data to review the appropriateness of referrals and try to improve this. A larger project could assess impact of hot slot usage on patient outcomes.