From Scoring to Shared Decisions: Improving Frailty Assessment Before Surgery

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R John¹; G Isbister¹; G Whitlow¹; N Lochrie¹

¹ Department of Clinical Gerontology, King’s College Hospital NHS Foundation Trust, London

Perioperative care for surgical patients

Abstract

Introduction
Frailty increases vulnerability to adverse perioperative outcomes. The Centre for Perioperative Care (CPOC) and British Geriatrics Society (BGS) perioperative guidance advocates identification of frailty alongside multidisciplinary assessment, optimisation and shared decision-making (SDM) throughout the surgical pathway. Accurate frailty recognition is therefore essential. We aimed to improve completion and accuracy of Clinical Frailty Scale (CFS) assessment and evaluate subsequent anaesthetic involvement and SDM.

Method
We evaluated completion of documented CFS scores at pre-operative assessment during three cycles of quality improvement work. We compared scoring accuracy against independent retrospective assessment and explored subsequent anaesthetic involvement and SDM. Interventions comprised incorporation of CFS into the nursing pre-operative assessment proforma, followed by targeted CFS education after scoring inaccuracies were identified.

Results
Initial CFS completion increased from 55.9% (19/34) to 76.5% (26/34). Following incorporation of CFS into the nursing pre-operative assessment proforma, completion reached 98% (49/50). However, only 47.7% (21/44) of paired assessments showed exact agreement with independent assessment, with 36.4% (16/44) under-scored. Following targeted teaching, completion reached 100% (25/25), exact agreement improved to 60% (15/25), and under-scoring fell to 24% (6/25). Post-intervention data also demonstrated anaesthetic involvement and documented SDM, with discussions involving patients, families and multidisciplinary teams informing perioperative planning.

Conclusion
Embedding CFS within the pre-operative proforma substantially improved completion but exposed inaccuracies in scoring. Targeted education subsequently improved accuracy and reduced under-scoring. Combining structured screening with staff education can improve frailty assessment and support multidisciplinary perioperative care and SDM.