Frailty screening on admission using a Clinical Frailty Scale (CFS) and the implementation of Advanced Care Planning

Introduction

Accurately identifying frailty at the front door is vital for guiding patient-centred care and Advanced Care Planning (ACP). Our quality improvement project set out to evaluate how effectively we assess frailty using the Clinical Frailty Scale (CFS) in patients over 65 admitted to Care of the Elderly (COTE) wards, looking specifically at completion rates, assessment timing, and ACP documentation.

Method

We first collected baseline data retrospectively for 35 frail patients admitted to COTE wards between December 2025 and February 2026, reviewing their records for CFS scores and ACP documents. Recognising a significant gap in our initial frailty assessments, we introduced a simple but effective intervention: making CFS documentation a mandatory field within the initial medical clerking notes. To measure the impact of this change, we then re-audited a new sample of 34 frail patients between March and April 2026.

Results

Our baseline audit revealed that while a reassuring 83% of patients had documented ACP discussions, only 49% had a formally assigned CFS score. We also noticed significant delays in these assessments, with some taking up to seven days. The intervention dramatically improved our performance: our re-audit showed a 100% (34/34) CFS completion rate. Crucially, assessments were completed much earlier in the patient's journey, with a median time of just 30 minutes. Meanwhile, our ACP documentation rate remained solid at 76.5%.

Conclusions

Embedding the CFS into routine admission clerking successfully transformed our compliance from 49% to 100%, completely eliminating the previous assessment delays. By capturing frailty accurately right at the front door, we are better equipped to make informed, patient-centred decisions early on.