A 24-Hour Frailty Admission Pathway to Improve Continuity of Care and Early Discharge: A Quality Improvement Initiative

Introduction 
The Acute Frailty Service at Whittington Health NHS Trust provides Comprehensive Geriatric Assessment for frail patients attending the Emergency Department and acute wards during weekday working hours, focusing on same-day discharge. Patients who narrowly missed discharge were transferred to general medical teams, disrupting continuity of frailty care and potentially delaying discharge. In the absence of a dedicated frailty inpatient unit, a 24-hour Frailty Admission Pathway was introduced for patients expected to be discharged within 24-48 hours. We aimed to improve continuity of care and facilitate early discharge /admission avoidance without compromising patient safety. Following initial implementation, the pathway was re-assessed through a second PDSA cycle. 

Methods 
Outcomes from matched spring periods were compared: baseline (2024, n=167), PDSA cycle 1 (2025, n=116) and cycle 2 (2026, n=138). Measures included early discharge, admission avoidance, pathway utilisation and Clinical Frailty Scale (CFS). Balancing measures included 7-day reattendance and 30-day readmission and mortality. Length of stay (LOS) was assessed using supplementary audit data. 

Results 
Same-day/24-hour discharges increased (26%, 39%, 52%), while admissions fell (74%, 61%, 48%). Estimated admission avoidance increased (26%, 37%, 51%), and discharges via the pathway rose from 23% to 55%. Mean CFS remained stable (6). Reattendance (2.4%, 4.3%, 4.3%), readmission (4.2%, 8.6%, 5.1%) and mortality (0.6%, 0%, 1.4%) remained low despite increased early discharges. LOS fell from 20.6 to 16.3 days over a three-year period.  

Conclusion 
Introduction of the pathway improved continuity of care, which was associated with an increase in early discharges, admission avoidance, shorter LOS and no increases in reattendance, readmission, or mortality. The trial operated successfully within budget constraints for the Frailty and Acute Medicine Service. These findings suggest the pathway is a feasible and safe admission alternative for selected geriatric patients, where a dedicated frailty unit is unavailable. Larger studies are required to demonstrate scalable equivalence.