Clinical Frailty Scale (CFS) Assessment in Urology Emergency Patients: How are we doing?

Introduction: 

Clinical frailty affects over 1.5 million people in the UK in 2025. The Clinical Frailty Scale (CFS) is a validated tool recommended nationally for assessing frailty in all emergency hospital admissions over 65 years. Frailty assessment is important for surgical admissions as a CFS score ≥4 is independently associated with increased rate of complications and mortality. The aim of this project is to improve the assessment of frailty in emergency urology admissions at the Alexandra Hospital using the documentation of a CFS score as a primary outcome and social history documentation as a secondary outcome. 

Methods: 

A baseline audit in January 2026 was undertaken of all emergency Urology admissions aged over 65. Electronic records were retrospectively reviewed for CFS and social history documentation on admission. Intervention involved planning and delivering a teaching programme to surgical resident doctors on frailty and post-operative complications associated with frailty alongside training on how to use the free CFS smartphone app. This was re-audited in March 2026.  

Results:

There were 54 admissions in January and 80 admissions in March. CFS documentation improved from 6 (11%) to 30 (38%) after intervention. Social history documentation improved from 20 (37%) to 42 (53%).  In January, 4 (67%) of the admissions assessed for frailty had a CFS score ≥ 4 with a median frailty score of 5.5 (Interquartile range 2-6). Of the admissions in March with a documented frailty score, 17 (57%) had a CFS score ≥ 4, with a median frailty score of 4 (Interquartile range 3-5).

Conclusion:  

A departmental teaching programme improved frailty screening documentation three-fold and shows a targeted intervention that can raise frailty awareness in surgical specialities. When emergency urology admissions over 65 years were assessed for frailty, there was a high proportion with a CFS score ≥4. Despite these improvements, CFS documentation was still below the national recommendation of 100%, and a further PDSA cycle will focus on standardising the use of a clerking proforma which mandates CFS assessment will aim to further improve CFS documentation.