Clinical Frailty Scale modifier for Manchester Triage System

INTRODUCTION: Older adults living with frailty triaged by the Manchester Triage System (MTS) as low acuity had high admission rates, suggesting under-triage. We tested a Clinical Frailty Scale (CFS)-based modifier to improve MTS accuracy in patients aged ≥65, comparing triage category agreement with clinical outcomes over a three-month period.

METHOD: A structured quality improvement approach was used. Baseline data was analysed, triage processes mapped, and a measurement plan developed. The new process was co-designed with Acute Medicine consultants, triage nurses, and consultant Geriatricians, supported by SOP development and targeted training. Implementation used PDSA cycles. 

RESULTS: A CFS based modifier was tested for people aged ≥65 years in MTS categories 4 (standard) and 5 (non-urgent). People who underwent CFS based modification had a weekly admission rate of 91.5%, exceeding the expected 10–30% for these triage categories. The triage modification allowed this cohort to be assessed an average of 60 minutes earlier by a clinician. Staff feedback echoed improved recognition of acuity in the department. This supports our hypothesis that a CFS based modifier could improve the accuracy of MTS in people aged ≥65 years living with frailty.

CONCLUSION(S) Our results suggest that MTS may under-triage some older people living with frailty into lower categories, and that the use of a CFS-based modifier could help to more accurately prioritise care by better reflecting the clinical complexity of this group. In our department, the intervention appears to have enhanced early recognition of frailty, which supports more tailored care pathways, improves safety through more timely escalation, and contributes to greater service-level awareness of demand and acuity.