Identifying frailty in the Emergency Department-feasibility study

Area of Science:

• Gerontology
• Emergency Medicine
• Health Services Research

Background:

• Identifying at-risk older adults in Emergency Departments (EDs) is crucial for clinical practice and service improvement.
• Implementation strategies for risk stratification tools in emergency care are not well understood.

Purpose of the Study:

• To determine desirable characteristics for a risk stratification process for older people in EDs.
• To evaluate the practical implementation of candidate frailty tools among ED clinicians.

Main Methods:

• Consensus building (focus groups, literature review) defined ideal tool characteristics (brevity, simplicity, multidimensionality).
• Four candidate tools (Identification of Seniors At Risk, Clinical Frailty Scale, PRISMA-7, Silver Code) were tested.
• Clinicians (n=121) assessed tools using vignettes in semi-structured interviews, evaluating speed, ease of use, and agreement with clinical judgment.

Main Results:

• Ideal tools are brief (<1 min), simple, and multidimensional.
• 75% of staff indicated willingness to reuse at least one tested tool.
• No significant differences were found between tools regarding completion time (median ~1 min), ease of use, or agreement with clinical judgment.

Conclusions:

• Validated risk stratification tools for older adults in EDs are practical for implementation.
• These tools are perceived as quick, simple, and easy to use by ED staff.
• High staff willingness to reuse tools suggests potential for successful integration into routine emergency care.