Abstract
Background
For patients aged ≥65 awaiting elective hip or knee surgery to be appropriately referred to a Perioperative Care of the Older People Undergoing Surgery (POPS) clinic, an accurate Clinical Frailty Scale (CFS) score is essential. Following the launch of a trial POPS clinic at Royal Surrey Foundation Trust, we compared referral letter CFS scores with those assessed by frailty-trained professionals. 75% of referrals lacked a CFS score, 12.5% differed, and 12.5% matched. To improve scoring accuracy and support appropriate referrals, we developed a CFS Scoring Toolkit, including a patient-led questionnaire and accompanying scoring system to generate CFS scores without specialist input.
Method
The CFS Scoring Toolkit was based on Rockwood Clinical Frailty Scale and supported by NHS Elect Frailty application. It was piloted in two outpatient settings: Frailty Same Day Emergency Care (FSDEC) and a geriatric clinic. Over one month, 54 questionnaires were completed and analysed, comparing toolkit-generated CFS scores with those in clinical notes and derived from NHS Elect app.
Results
There was variation in CFS scores between the toolkit, clinical notes, and the NHS Elect app. The toolkit identified more CFS 5 and 7, but no CFS 6. Scores matched across all three sources in 30% of cases (CFS 3–5). The toolkit underscored CFS 5 in 15% and overscored in 32%; 6% at CFS 5, 26% at CFS 7. Compared with clinical notes, 33% matched, 56% differed by one point, 4% differed by two points, and 19% were non-comparable. Compared with the app, 52% matched, 44% differed by one point and 4% differed by two points. 72% found the questionnaire user-friendly; 63% needed help.
Conclusion
Full concordance was not achieved, though the toolkit aligned more closely with the NHS Elect app CFS. The toolkit is undergoing refinement and will be re-evaluated in the same settings.