Frailty SDEC& Front door team

Frailty  SDEC & Front door team

University Hospital of North Midlands NHS Trust is 1500 bed tertiary care hospital in Stoke-on Trent, UK

Frail elderly patients account for a significant proportion of emergency attendance to our Emergency Dept. Early assessment and clinical decision making is vital for these groups of patients and specialist assessment at the front door can prevent unnecessary admissions and also reduce the risk of complications such as delirium, deconditioning and hospital acquired infections. 

Inorder to improve the care of frail older patients presenting to ED, we developed the following services in 2025. 

1.We opened a Frailty Same Day Emergency Care Unit ( SDEC)  in October 2025. This was done by converting 2 bays of FEAU to SDEC area and using FEAU beds as short stay beds.

2.  Geriatrician in reach to ED started in Feb 2026- proactive working in parallel with acute medical team seeing frail medical patients in ED. 

3. Silver phone line- to support the community teams, so that community team or ambulance team can discuss cases with Consultant Geriatrician and decide whether patient can be treated in the community or needs conveyance to ED

SDEC proactively identifies suitable patients from ED and also accept patients following referrals by Ambulance service. The service operates 7 days a week from 8am to 8 pm. Experienced Frailty advanced nurse Practitioners ( ACP) act as competent/ senior clinical decision makers; while the SDEC Consultant act as the expert clinical decision maker and maintaining the overall responsibility.

The new service was started by reallocating existing clinical staffing and releasing ACP and nurses from the wards to cover SDEC. From October 2025 till May 20226- SDEC saw over 1600 patients of which 70% were discharged the same day. This has resulted in significant reduction in the number of admissions for frail elderly patients. Patients treated in SDEC have high patient satisfaction as most patients are treated and returned to their homes or care homes. The service has also helped to reduce the ambulance waits and improve ED performance ( ED performance better than the same period last year). Direct admissions from ambulance services helps to release ambulances to attend other emergencies.

ED in reach by Consultant Geriatrician(Monday- Friday)  helps with early specialist assessment and senior clinical decision making for frail patients and identifying patients for the correct portal of admission – eg SDEC/ FEAU/ wards. This has resulted reducing admissions, avoiding multiple transfers and improved patient satisfaction. Assessment of Frail patients in ED by Geriatrician makes us compliant with NHS England/ GIRFT standard for Urgent and Emergency care.

These new service developments have resulted in 75% of Frail elderly medical patients attending ED receiving specialist review and care by the frailty team (compared to 30% previously)

The above service improvements have been made possible by committed and collaborative working between medical team, ACP, nursing team and IDH together with strong clinical leadership. The patients treated by Frailty team  received multidisciplinary holistic assessment with kindness and compassion. The staff working have the specialist skills and are passionate and work together as team to produce the best outcome. The staff have been flexible and has worked differently to make the Front door frailty service a success.

The Silver phone line has helped to reduce number admissions from care homes who would have otherwise been conveyed to ED.

One the main challenges have been the different way of working for many clinical staff and seeing the positive results have embraced the new service. It also gives staff opportunity of professional development and acquiring new skills. Staffing resources, getting the funding for developing the service and also the physical space for SDEC have also been challenging.

Despite the challenge, the team have embraced the core values of togetherness, Kindness and excellence and have strived to achieve best outcomes for patients