Implementing early Comprehensive Geriatric Assessment in a rural DGH:

Introduction: 

The 2025 the Pembrokeshire inpatient census showed 75% of over 65-year-old inpatients have a Rockwood Clinical Frailty Score (RCF) ³>/=5, and 90% have one >/=4, highlighting a significant prevalence of frailty within this area. The Comprehensive Geriatric Assessment (GCA) is an evidence based aspiring practice for treating patients living with frailty. The Withybush Frailty Pathway model implements early identification of frailty, access to the MDT and continuity of consultant care retained throughout hospital stay.  

Methods: 

Patients presenting to Withybush Hospital with a RCF >/=4, NEWS2 score <4 and a medical condition not requiring other specialist input were allocated the frailty pathway. Patients were transferred to the next available frailty bed. If there was a shortage of bed space the team outreached to ED to ensure early frailty MDT input. All patients were discussed at a daily frailty MDT board round.

Results: 

There were 1228 admissions to the acute frailty unit and geriatric ward between dates June 2025 - June 2026, compared to 839 admissions the prior year, demonstrating increased access to early GCA. As a result, there was an 11% reduction in frailty bed occupation from peak of winter 2025/26 to April 2026 using this model. Further, when compared to August 2025 a 19% reduction in frailty bed occupancy is seen. The mean length of stay in the frailty pathway decreased from 31 days in April 2025 to 11days in June 2026. In July 2026 there was one patient with a length of stay >50 days across the frailty pathway. 

Conclusions: 

Overall, our data demonstrates that implementation of early CGA and MDT input decreases length of stay and increases discharges. Our future goals would be to also reduce re-admission rates and length of stays >50 days across the whole system including rehabilitation hospitals.