Improving Clinical Frailty Scale documentation in surgical admissions of older patients: A Quality Improvement Project

INTRODUCTION
The Surgical Emergency Unit (SEU) at John Radcliffe Hospital, Oxford assesses a wide range of patients daily, including a significant proportion aged ≥65 years. However, current clerking proformas lack a dedicated section for frailty scales, often resulting in omission. Accurate and consistent documentation of frailty using the Rockwood Clinical Frailty Scale (CFS) supports perioperative optimisation and surgical decision-making, designed to avoid age-related bias and discrimination. As per trust policy, all patients aged ≥65 with unplanned admissions should have a CFS recorded. This audit and Quality Improvement Project (QIP) aimed to improve CFS documentation within SEU.

METHODS
A cross-sectional study of SEU admissions over a 2-week period was undertaken for patients aged ≥65. Data analysed included age, co-morbidities, diagnosis, CFS, admission reason and length of stay. Interventions were then delivered to clinicians in SEU including informative educational sessions, presentations at the departmental journal club and walk through sessions on utilisation of the CFS app. A repeat cross-sectional study was undertaken post-intervention to assess impact. Statistical analysis was performed to interpret the data.

RESULTS
The initial dataset included 73 patients (n=73) (median age 80; range 65–100 years), with only 20% (n=15) having a documented CFS. Post-intervention, 79 (n=79) patients were identified (median age 81; range 65–94 years), with CFS documentation rising to 35% (n=28) of patients; a 15% improvement in documentation.

CONCLUSIONS
CFS documentation in SEU remains below trust standards, however, targeted education led to a notable increase in adherence to trust policy. Our intervention is scalable, easy to implement, and effective. Further work will be undertaken to promote the use and clinical benefit of CFS awareness and documentation for surgical patients. Continued focus on frailty identification may enhance perioperative care, promote tailored surgical planning, and improve overall outcomes for older patients attending SEU.