Analysis of a Frailty Same Day Emergency Care (fSDEC) Pilot at a District General Hospital in Somerset

Background: Frailty is strongly associated with delayed emergency assessment, prolonged hospital admission, functional decline and in-hospital mortality. The importance of the integration of fSDECs into acute medical care is highlighted by the NHS FRAIL strategy and the RCP[1]. Musgrove Park Hospital is a rural DGH serving a significantly higher percentage of older adults than the national average (>25% vs 18.5%)[2]. We have introduced a fSDEC pilot that aims to facilitate early comprehensive geriatric assessments (CGA) and avoid unnecessary admissions. We plan to identify barriers in this process, adapt, and expand the service in line with the NHS long term plan.

Methods: Over an eight-week period, geriatricians selected 22 patients via a referral pull technique with the following inclusion criteria: aged 65 or over, clinical frailty score (CFS) 4-7, recognised frailty syndrome, being ambulatory, and referral in hours.

Results: Of 22 patients, 21 (95%) were referred from ED, whilst 1 (5%) was a direct community referral. The average time taken for ED to calculate a CFS was 7.8 hours (ranging from 31 mins to 17 hours). Time until CGA in fSDEC was <1 hour for all patients. 3 patients (13.6%) were admitted to appropriate COOP/AFU wards with an average admission of 12 days. 19 patients (86.4%) were discharged the same day, 9 (47.4%) with community support following therapy review. Two patients (9.1%) were readmitted within 30 days of fSDEC review.

Conclusion: Whilst we acknowledge the small sample size, the majority of patients seen in the fSDEC pilot received rapid access, CGA-based care and same-day discharge with a low readmission rate. We have highlighted challenges to overcome including a lack of current referral pathways, availability of rapid-access imaging, and necessity of regular fSDEC staff. We will continue to evolve the service with the aim of implementing a permanent fSDEC.