Acute Practitioners' Experiences of Implementing Frailty Same Day Emergency Care: A Researcher-in-Residence Study

NHS policy promotes Frailty Same Day Emergency Care (F-SDEC) units to alleviate pressure on emergency departments (ED) and improve care for frail people through comprehensive geriatric assessment and same-day discharge. However, evidence remains limited on how such services are implemented in practice, particularly in resource-constrained and geographically peripheral settings. This study aimed to examine how implementation barriers are experienced and negotiated during the day-to-day delivery of an F-SDEC pilot.

Using a Researcher-in-Residence approach, a researcher embedded in a coastal hospital in Torbay, South-West England, collected field notes from prior observations to inform the interview guide, conducted semi-structured interviews with staff delivering F-SDEC, and held a feedback session. A framework-informed, reflexive thematic approach guided the identification of key implementation challenges and enablers.

Staff viewed F-SDEC as beneficial for improving care for older adults, but interacting barriers constrained implementation. ED-based triage was time-intensive and difficult to routinise due to fragmented, non-interoperable IT systems, inconsistent understanding of frailty across hospital teams, and shifting eligibility criteria. Operational pressures, workforce and skill-mix shortages, and an inconsistent understanding of F-SDEC's needs and purpose also limited CGA delivery and contributed to day-to-day variability in throughput. While staff expressed a desire to reorient towards community-based referrals, the same digital and workforce constraints also limited the feasibility of alternative routes, further raising sustainability concerns.

F-SDEC implementation was shaped by interdependent system constraints rather than isolated barriers. In peripheral and resource-constrained settings, successful implementation may depend on whole-system alignment across digital infrastructure, workforce capacity, and cross-team collaboration, with national policy better accounting for local delivery conditions.