Abstract
Background: Frailty is a multidimensional syndrome characterised by diminished strength, physiological reserve and increased vulnerability. Psychiatric inpatients are a high‑risk, often overlooked population. They typically have reduced life expectancy and are frequently excluded from most research, which leaves their complex healthcare needs unmet. By identifying frailty in this cohort, clinicians can more accurately stratify risks and tailor interventions to each patient’s unique vulnerabilities, and ensure that frailty considerations inform best‑interest decisions. Closing this critical gap in care not only enhances patient safety but also drives more patient centred, effective treatment for a profoundly vulnerable group.
Methods: An initial options appraisal was done comparing five frailty scales. The Edmonton Frailty Scale (EFS) was selected following a feasibility study for its comprehensive coverage of cognition, mood, nutrition, polypharmacy, continence, and social support rather than focusing solely on cognitive function. An ongoing Quality Improvement project was then launched to complete frailty assessments and embed them into routine clinical practice. This work began initially on two pilot wards. Currently the project is being extended to other wards with the aim of rolling out the EFS hospital‑wide.
Intervention:
The acute‑care version of EFS was embedded into the electronic record system and mandated its completion for all eligible patients. A sustained 95–100% completion rate was seen on the participating wards. Comprehensive Geriatric Assessment clinics (CGA) are planned to take place for each patient every 6 months, led by a consultant geriatrician and the respective ward doctor. Although the E‑Learning for Health Tier 1 frailty module was rolled out, it could not be imported onto the hospital’s learning platform, resulting in prolonged access delays for staff. A pre intervention staff survey in December yielded mixed feedback, which has been instrumental in refining the approach for the ongoing cycle. Initial attempts to raise frailty awareness through governance meetings and ward huddles were hampered by other compulsory training priorities, so dedicated reflective practice sessions were instituted on each ward.
Next Steps:-
- Ward Expansion: Roll out dedicated reflective practice sessions along with CGA clinics across wards.
- Follow‑Up Survey: Conduct a second staff survey to evaluate changes in frailty awareness and EFS utility.
- Ongoing Monitoring: Continue tracking EFS completion rates and associated care‑plan actions to ensure sustained uptake.
- Data Driven Refinement: Use the survey feedback and clinical outcome data to improve training and governance processes.
Conclusion: Initial Quality Improvement interventions have demonstrated the feasibility of embedding frailty assessment into psychiatric care. By integrating the EFS into patient care, near completion rates were achieved and frailty awareness significantly improved. This has led to earlier identification, more tailored care plans, and better informed decisions for a vulnerable, often overlooked patient group. These practices are being expanded to additional wards, and methods are being continuously refined using staff feedback and clinical data, thereby embedding frailty recognition and management as routine components of patient care. This project offers a practical, scalable model for enhancing frailty care in psychiatric inpatient settings.