Abstract
Introduction:
This study of patients attending East Surrey Hospital’s (ESH) Frailty Same Day Emergency Care (FSDEC) unit was designed to assess the interrelationship between onward destination from FSDEC, including existing location-based virtual wards (VW) offering ongoing care and remote monitoring at home, outpatient clinics and comorbidity. In ESH in October 2024, a 6-space FSDEC was created. Patients are pulled from the ED in the morning, with a small number being referred from GPs and community Urgent and Emergency Care teams.
Method:
Data were reviewed from February 2025 to April 2025, in this time, for all 285 patients attending ESH FSDEC, patient records were reviewed to determine onward destination from FSDEC and to calculate Charlson Comorbidity Index (CCI). Outcomes included discharge to usual residence, discharge home under the care of a VW, or admission to further acute care. Additionally, any planned follow-up at point of discharge from FSDEC was recorded.
Results:
Of the 285 patient encounters, 212/285 (74%) were discharged on the same day, 149/285 (52%) were discharged home, 63/285 (22%) were discharged under the care of a VW and 73/285 (26%) were admitted as inpatients. 80/285 patients (30%) attending FSDEC were discharged with planned follow-up outpatient appointments with a geriatrician or another specialty. CCI scores ranged from 3-11, with a mean score of 6.
Conclusion:
This study provides evidence to support the East Surrey Hospital FSDEC model of care, with 74% of patients attending being discharged home the same day. The study shows a large proportion of patients, 22%, receive care & monitoring at home under a VW following discharge, a vital method of admission avoidance; suggesting these two services are important to be commissioned together. Analysis of Charlson Comorbidity Index scores also demonstrates the complex health background of those attending FSDEC and their need for specialist care.
Comments
A great step for frailty services
As someone with an interest in frailty, it's fantastic to see such great results from the implementation of a FSDEC. Utilising local virtual wards is a great way to reduce admissions. Which part of the service do you feel was the hardest to implement?
I think the hardest part to…
I think the hardest part to implement was the culture change to use the sdec and the change in risk perception of the MDT.
Virtual ward outcomes
Interesting study, seems like the FSDEC is a good initiative.
It would also be interesting to know what percentage of patients referred to the virtual ward/discharged home with no support ended up being re-admitted to hospital
I don't have this to hand…
I don't have this to hand. But it's quite low. We plan to look at this in the new year.