Evaluating the impact of implementing additional hours of Frailty Services in ​the Emergency Department​

Introduction

Early identification and multidisciplinary management of frail patients in acute care is a national priority, as reflected in the NHS Long Term Plan1, NHS Improvement (NHSI)2, and Getting It Right First Time (GIRFT)3. Sunderland Royal Hospital’s acute frailty services run daily from 08:00–20:00 across the Emergency Department (ED) and Emergency Admissions Unit (EAU), assessing patients with a clinical frailty score (CFS) ≥5. Morning duties are primarily dedicated to reviewing overnight admissions on EAU, which can lead to a delay in assessment of new patients arriving in ED. As part of a pilot study, winter pressures funding was allocated for additional frailty presence in ED from 08:00, aiming to assess the impact on patient outcomes.

Methods

Following ED triage patients were given a CFS. Those with a CFS≥5 who were not identified by ED as being suitable for discharge or better managed by an alternative specialty were reviewed by the frailty team. Retrospective data was collected from a trust-generated database for two one-month periods (January 2024 and January 2025) to allow a comparative analysis.

Results and Discussion

Between 08:00-12:00 there were 403 patients in ED in January 2024 with a CFS ≥5 compared to 527 in January 2025. Following implementation, comprehensive geriatric assessments (CGAs) in ED increased significantly from 42 to 131 (p<0.05), with a particular increase in CGAs during additional operating hours (16.7% vs. 42.7%, p<0.05). No significant change was seen outside this timeframe. This data suggests that expanding frailty services facilitates earlier completion of comprehensive geriatric assessments for frail patients in ED.

The proportion of patients discharged directly from ED increased significantly from 35.2% (N=142) to 42.3% (N=223) (p=0.02). This demonstrates that early CGAs are key to coordinating safer discharges and reducing avoidable admissions. While the overall proportion of patients admitted under elderly medicine remained similar between the two data sets (57% vs. 52%), a significant increase was seen in direct admissions to elderly medicine wards, allowing patients to bypass EAU (8.4% vs. 18.8%, p<0.01). This highlights the impact of early CGAs in improving patient flow and facilitating direct access to specialised care.

Finally, the impact on length of stay can be seen when comparing patients admitted <7days under elderly medicine in January 2024. There was a significant reduction in mean length of stay between those who had a CGA (3.6 days, N=50) versus those who did not (4.5 days, N=18) (p=0.04). This shows early CGAs contribute to a reduced length of stay for frail patients admitted <7days.

Conclusion

Increasing the number of CGAs in ED has been proven to positively impact patient outcomes by allowing access to comprehensive geriatric assessment at the earliest opportunity. The frailty team’s additional presence enabled significantly more of these assessments to take place, leading to a reduction in the number of admissions, earlier access to specialised care for those requiring admission and improved patient flow. The findings of this pilot support further investment in expanding acute frailty services to optimise care pathways for frail patients and improve overall hospital efficiency.

References:

1. NHS England. The NHS long term plan. Version 1.2. NHS England; 2019. p. 22-24. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
2. NHS England. FRAIL strategy [Internet]. NHS England; 2024 [cited 2025 Mar 22]. Available from: https://www.england.nhs.uk/long-read/frail-strategy/
3. Getting It Right First Time (GIRFT). Geriatric medicine report. NHS England; 2021. p. 41-43. Available from: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/Geriatric-Medicine-Sept21h.pdf