Death and dying amongst patients reviewed by a front door frailty service: a retrospective audit

1. Introduction

Frailty is increasingly common in older age and is associated with poor outcomes including increased morbidity and earlier death. Hospitals often utilise front door frailty (FDF) teams to provide comprehensive geriatric assessment for frail patients attending emergency departments (ED) This audit relates to a FDF service which provides inreach into an ED in which advanced clinical practitioners (ACPs) review and treat frail patients presenting with medical complaints. 

2. Method

All patient records of those seen by frailty ACPs between April 1st 2026 and June 30th 2026 were reviewed retrospectively. Data gathered included whether they had died within 1 month of having been seen by the FDF team, their age, clinical frailty score, and whether they had been admitted to hospital. We also reviewed if they already had a RESPECT form, and whether a RESPECT form was completed following review. 

3. Results

376 patients were reviewed by the frailty ACPs within the specified timeframe and of these 20 died within 1 month (5.3%). The average age of those who died was 86 years old (range 76-99) and the vast majority had a clinical frailty score of 6-8. At the point of attendance to ED 176 patients (52%) had a RESPECT form and 72 patients had a new form completed following review by the ACP. Of those who had a new form completed by the ACPs, the majority achieved their preferred place of death. 

4. Conclusion(s)

One month mortality amongst patients seen by an acute frailty service is relatively high, especially with high frailty scores and older ages. This underscores the importance of advance care planning – even in those who do not appear to be imminently dying. This audit reveals that advance care planning can be done effectively and efficiently by FDF services.