Improving Care Quality of Older Patients: Reflections on the Introduction of Geriatric Expertise in a District General Hospital

Background: Frailty is associated with increased healthcare costs, accounting for over £5.8 billion annually in the UK (1). Frail adults experience higher rates of hospital admission, yet these patients often receive delayed assessment and specialist review. Comprehensive Geriatric Assessment (CGA) and early geriatric involvement have been shown to improve outcomes, including reduced length of stay (LOS) and readmission rates. In September 2025, a district general hospital serving over 250,000 residents, with an above-average population aged over 85 years (2), established its first dedicated geriatrics service following successful recruitment of two consultants and one specialty doctor.

Methods: This reflective service evaluation examined changes in frailty-related performance indicators following implementation of the geriatrics department. Outcomes were assessed using the GIRFT Elderly caRe Index (GERI), a national benchmarking tool for geriatrics. Measures reviewed included overall GERI ranking and score, prolonged LOS (>21 days) among frail emergency admissions, and rates of patients experiencing over 2 hospital readmissions annually. Informal multidisciplinary staff feedback was also considered.

Results: The hospital demonstrated marked improvements across multiple metrics. National GERI ranking improved from 157th in December 2024 to 33rd in December 2025, moving from the lowest quartile to the highest quartile. The GERI score improved despite winter pressures, increasing from 99 to 92 by early 2026. The proportion of frail emergency admissions with LOS exceeding 21 days fell from a range of 22–26% to an average of 20.9%, with performance below 20% achieved for the first time. Readmissions also declined overall during winter months. Staff feedback highlighted improved patient management and enhanced multidisciplinary learning.

Conclusions: Introduction of specialist geriatric expertise was associated with substantial improvements in frailty-related outcomes, patient flow, and quality of care. Expansion of front-door frailty services and continued investment in the department will likely improve outcomes for frail patients in this hospital.

1. Han L, Clegg A, Doran T, Fraser L. The impact of frailty on healthcare resource use: a longitudinal analysis using the Clinical Practice Research Datalink in England. Age and Ageing [Internet]. 2019 Jul 12;48(5):665–71. Date accessed: 04/05/26.    
2. Health. Local health, public health data for small geographic areas - Data | Fingertips | Department of Health and Social Care [Internet]. Phe.org.uk. 2026 [cited 2026 May 19]. Available from: https://fingertips.phe.org.uk/profile/local-health/data#page/0/gid/1938…. Date accessed: 19/05/26