Frailty stratification in the emergency department using the triage frailty and comorbidity tool

Frailty is increasingly recognised as a key determinant of adverse outcomes and resource use in the Emergency Department (ED), yet pragmatic, scalable strategies for timely identification and management are lacking. We evaluated a workflow-compatible frailty stratification model by embedding the Triage Frailty and Comorbidity (TFC) Tool into routine triage for low-acuity patients.

We conducted a multicentre observational study in two Italian EDs. Adult patients triaged as Manchester Triage System (MTS) green/blue were eligible. As part of triage completion, nurses completed the TFC Tool; TFC ≥ 5% defined positivity. For TFC-positive patients, the waiting-list order was prioritised within the same MTS category. Primary outcome was time from triage completion to medical evaluation; secondary outcome was hospitalisation.

Among 40,568 eligible visits, 1269 (3.1%) were TFC-positive (0.3% in 18-65 years; 9.8% in ≥65 years). In adjusted models, TFC positivity was associated with a + 1.45 (95%CI 1.19-1.70) minute longer triage duration but reduced waiting time to medical evaluation by -15.06 min (95%CI -20.85 to -9.27). Hospitalisation occurred in 19.4% of TFC-positive vs 4.8% of TFC-negative patients; TFC ≥ 5% was independently associated with admission (adjusted OR 1.69, 95%CI 1.43-1.99), and TFC as continuous increased admission odds per 1% point (OR 1.05, 95%CI 1.04-1.06).

Routine implementation of the TFC Tool within standard triage was associated with shorter waiting times to medical assessment among vulnerable low-acuity patients, while maintaining acuity-based prioritisation. TFC positivity was also associated with higher odds of hospitalisation.