Factors associated with discharge home following acute frailty assessment: a single-centre audit

Introduction 

The Acute Frailty Team (AFT) in Darlington Memorial Hospital (DMH) assess patients over 65 living with frailty. Some, based on local criteria, are streamed to the Frailty Assessment Unit (FAU), aiming to avoid acute admission. This audit examined whether 4 A's Test (4AT), Early Warning Score (EWS), clinical frailty score (CFS) or presenting complaint (PC) were associated with discharge home, and whether FAU assessment increased this. 

Methods 

Data was collected on patients seen by AFT between 1st and 31st May 2026. 161 patients were seen within FAU and 165 outside. 4AT, EWS, CFS, PC and discharge destination were recorded, 4AT was unavailable for one patient. 'Home' was defined as usual address with or without Hospital at Home. Groups were compared using Chi-square or Fisher's exact test when expected counts were below five. Cochran-Armitage was used for trend analysis.  

Results 

Home rates fell as 4AT rose: 62% at 4AT 0, 39% at 1-3, and 22% at 4+ (trend p<0.0001). FAU discharged more patients home than outside FAU at 4AT 0 (74% vs 40%, p<0.001) and 4AT 4+ (48% vs 10%, p<0.001). Within FAU, discharge home occurred in 9/9 patients with delirium from care/nursing homes versus 5/20 from their own home; outside FAU, 2/15 and 5/53, respectively. Discharges home also fell as EWS rose: 51% at 0-2, 28% at 3-4, 27% (3/11) at 5+ (trend p=0.001). CFS showed no trend (p=0.75). PC of falls showed higher discharge from FAU than outside FAU (70% vs 35%, p<0.001). 

Conclusion 

Home discharge falls as 4AT and EWS rise, whereas CFS shows no trend. In most variables, FAU discharges more patients home, though data suffer selection bias, as patients likely for discharge are streamed to FAU. Patients most likely to be discharged home had EWS below three with 4AT of zero, or delirium with a supported residential setting.