Discrepancy in Clinical Frailty Score documentation in Vascular Surgical inpatients

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.