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Implementing an Acute Frailty Service in the Emergency Department: A Mixed-Methods Service Evaluation of Feasibility,
Yuhan Zhang1,2, Victoria Green3, Alex Montagu2
1Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
Background:
Older adults living with frailty present frequently to emergency departments (EDs), yet standard care is poorly adapted to their complex needs. National policy in England recommends Comprehensive Geriatric Assessment (CGA) and frailty-targeted pathways, but evidence on their impact in EDs is limited.
Methods:
We conducted a single-centre mixed-methods service evaluation using an observational comparative design to evaluate a new frailty service in a large urban ED (September 2023-March 2024), based on routinely collected data (Commissioning for Quality and Innovation (CQUIN) dataset) and a patient experience survey.
Results:
Among 5,717 eligible ED presentations (clinical frailty scale (CFS) ≥ 6), 464 (8.1%) received the acute frailty service (AFS) review and 5,253 (91.9%) usual care. AFS patients were older (mean 85.9 (SD 7.7) vs 81.0 (SD 12.3) years) and more often female (64.2% vs. 55.3%). Overall LOS was shorter for AFS patients (49.1 ± 48.5 h ≈ 2.0 days vs 106.4 ± 95.5 h ≈ 4.4 days; p < 0.001), driven primarily by admitted patients. Admission avoidance was achieved in 23% of AFS cases. Odds of hospital admission were lower (OR 0.14, 95% CI 0.087-0.231), while 30-day reattendance did not differ significantly (OR 0.84, 95% CI 0.51-1.36). No in-hospital deaths occurred among AFS-reviewed patients. Patient feedback (n = 24) showed high satisfaction with dignity, communication, and overall care. A simple cost-offset estimate suggested two admissions avoided per clinician shift, approximating local bed-day cost savings of £1,000 per day.
Conclusions:
Implementing a dedicated frailty service in the ED is feasible and may improve clinical outcomes and patient experience. Embedding specialist geriatric input early in the emergency pathway supports safe, efficient, and person-centred care for older adults. These findings offer transferable insights for acute and emergency care systems seeking to strengthen frailty management at the front door.
Statement Of Significance:
This study provides real-world evidence on implementing an acute frailty service within the emergency department and describes its reach, integration, and associated early outcomes for older adults living with frailty. The findings contribute to international efforts to optimise frailty management at the front door of acute hospitals, offering practical insights for integrated emergency and geriatric care.
