Five Years of The Surgical Acute Frailty Team (SAFT): Improving Frailty Identification and Assessment in Unscheduled Surgery

Introduction: Older adults undergoing emergency surgical admissions are at increased risk of delirium, adverse outcomes and hospital induced dependency. In our hospital, the Surgical Acute Frailty Team (SAFT) was established in March 2020 to provide early frailty identification, comprehensive geriatric assessment (CGA) and multidisciplinary intervention for older surgical patients based on the Centre for Perioperative Care Frailty Guidelines. Our aim was to establish the clinical activity of the service. 

Methods: A retrospective review of the clinical activity of SAFT from January 2021 to December 2025 was undertaken. Prospectively collected data was analysed to identify the number of patients screened for frailty on admission. This included frailty identification using the Clinical Frailty Scale Score (CFS) and delirium assessment through use of the 4AT score.  

Results: Over five years, SAFT screened 8,732 patients aged 65 to 102 years. Annual screening activity increased from 1,590 patients in 2021 to 1,830 patients in 2025 demonstrating sustained growth and service demand. 46.6% were female. 57.3% had a CFS score >4 confirming a high percentage of patients with moderate to severe frailty within our local emergency surgical population. Delirium screening identified 1,373 patients with a 4AT score >4. Early identification of delirium enables prompt intervention and delirium management by SAFT. 

Conclusion: Over its first five years, SAFT has delivered frailty and delirium screening for over 8,700 older surgical patients. Early frailty identification and delivery of CGA is essential in this population. The cumulative increase in patients assessed by SAFT reflects increased demand along with successful integration of our frailty-focused care within our acute surgical admissions. The review of our service supports the continued value of early frailty and delirium screening and delivery of CGA within our emergency surgical population.