Discrepancy in Clinical Frailty Score documentation in Vascular Surgical inpatients
Abstract
Introduction
An accurate Clinical Frailty Score (CFS) is a good predictor of surgical outcomes and should be documented correctly for all surgical patients. However, this is not always followed in practice.
This project aims to identify discrepancies in CFS documentation between Emergency Department (ED) triage and the POPS (Perioperative care for Older People undergoing Surgery) team and explore adherence to POPS recommendations.
Method
This was conducted by the POPS team in a district general hospital in England.
The CFS done preoperatively on vascular inpatients separately by ED triage nurses on arrival and by the POPS Physician on the same patients when moved to the ward on the same day were compared.
A retrospective review of 100 vascular inpatients, emergency and elective, admitted between 2024 and 2025 was conducted.
Results
Average patient age was 78 years.
Average CFS at triage was 4, and by POPS was 6.
ED CFS was underestimated in 63% of patients.
A higher CFS score was highlighted by the POPS team and impacted their recommendations, but this was often missed by the surgical team due to the discrepancy of CFS documented on triage.
Five patients underwent surgical interventions against POPS recommendations; three required new packages of care or institutionalisation on discharge and one died 78 days post discharge.
Patients whose perioperative management aligned with POPS recommendations demonstrated comparatively fewer postoperative complications and fewer escalations in care needs.
Conclusion
This study demonstrates the significance of correct CFS documentation, given its notable impact on surgical outcomes. It unmasked the need for training of ED triage nurses to facilitate accurate CFS scoring in alignment with the POPS Geriatrician.
Comments
Very interesting to see this…
Very interesting to see this done. Often you see on clerking notes and then senior review / op notes different scoring. I wonder how you could best deal with subjectivity between clinicians and their idea of the CFS score
Rockwood CFS score
Thank you for your thoughtful comment. I completely agree that using the Rockwood Clinical Frailty Scale (CFS) consistently, alongside better education and training on how to apply it, could help reduce subjectivity and scoring bias.
An important principle is that the CFS should reflect the patient’s baseline level of function and frailty before the onset of the acute illness, rather than how unwell or dependent they appear at the time of assessment.
Interestingly, in our findings, the discrepancies in CFS scores were already present on admission, with most assessments occurring on the same day. Therefore, the variation was unlikely to be explained by a change or deterioration in the patient’s clinical condition during their hospital stay.
This suggests that differences in clinicians’ understanding and application of the CFS may be an important contributor to the scoring discrepancies we observed. It reinforces the potential value of structured CFS education and training to improve consistency and reliability of frailty assessment.
Thank you again for raising such an interesting point.