Closing the Frailty Gap: Developing an Integrated Trauma and Perioperative Older Persons Service in a District General Hospital

Background 

Older adults with frailty presenting with trauma or requiring emergency surgery represent a high-risk population with complex medical, cognitive and functional needs. While specialist older persons surgical services are increasingly established in tertiary centres, many district general hospitals (DGHs) lack dedicated frailty provision for emergency surgical patients. This variation affects patient outcomes, adherence to national standards and workforce sustainability, highlighting the need for pragmatic, deliverable models within existing DGH resources. Our aim was to develop and evaluate the impact of a new integrated trauma and perioperative older persons service within a DGH emergency surgical setting.

Methods 

Iterative Plan–Do–Study–Act cycles were used to develop and embed a frailty service within emergency surgery, supporting trauma patients unsuitable for major trauma centre transfer, emergency laparotomy patients and older adults with complex multimorbidity. The service provided twice-weekly registrar-led comprehensive geriatric assessments and weekly consultant reviews. Beyond direct clinical input, it prioritised embedding frailty-aware practice across the wider team through education, multidisciplinary team integration and standardised referral pathways. A four-month retrospective baseline cohort (n=99) was compared with a six-month prospective intervention cohort (n=155), with qualitative data collected via structured surveys.

Results 

30-day readmissions fell from 25.3% to 16.1%. Emergency calls (9.1% to 7.7%) and ad hoc medical reviews (20.2% to 11.6%) both decreased. Treatment escalation planning increased from 41% to 63%, and medication burden improved, shifting from a mean increase of 0.8 medications to a net deprescribing effect of −1.05. Mean length of stay (8.89 vs 8.15 days) and 30-day mortality (10.1% vs 10.3%) remained stable. Feedback from colleagues, patients and relatives was consistently positive.

Conclusion 

This model demonstrates that structured, frailty-informed surgical care is achievable within a DGH with modest resources. Its flexible, dual trauma-perioperative design and emphasis on cultural change make it scalable and transferable to similar institutions.