Abstract
Introduction:
Frailty is common among older surgical patients and associated with poorer post-operative outcomes. Therefore, identifying at-risk patients for peri-operative optimisation is vital to improve surgical outcomes, yet national audits reveal it remains under-assessed (1). A review of a surgical ward showed that 0% of patients aged over 65 had a Rockwood Clinical Frailty Score (CFS) documented within 48 hours of admission. This QIP aimed to increase timely CFS documentation to 50% by January 2025 and 80% by June 2025 through structured interventions.
Method:
Following initial assessment, a staff survey and fishbone diagram were used to identify key barriers to timely CFS documentation: limited awareness of guidelines, unclear role responsibilities, and unfamiliarity with CFS tools. Weekly data collection began in August 2024 and was visualised using SPC charts. Two PDSA cycles were undertaken: PDSA1 focused on education through posters, e-learning, and QR-linked CFS tools. PDSA2 reinforced the 48-hour documentation target and introduced ward champions to promote adherence. Data was collected prospectively, and interventions were co-developed with ward staff.
Results:
Following PDSA1 (Nov 2024–Jan 2025), 48-hour documentation peaked at 25% in December, averaging 18% across the cycle. By early January, the rate was 17%. Total CFS completion (regardless of timing) reached 56.5%. During PDSA2 (Feb–Mar 2025), interventions focused on reinforcing the 48-hour target and introducing ward champions. This led to a peak 48-hour documentation rate of 44% by March, with total CFS documentation reaching 56.3%. Despite improvements, the target of 50% by January was unmet.
Conclusion
Although the 50% target by January 2025 was not achieved, CFS documentation within 48 hours improved from 0% to 44% through targeted staff education and ward-based initiatives. Sustained improvement will require ongoing reinforcement and integration into clinical systems. This project demonstrates the feasibility and value of embedding frailty assessment into routine surgical care.
Reference(s)
(1) Harrison S, Harvie DA, Wensley F, Matthews L, Denehan W, Barlow C, et al. Frailty in the over 65s undergoing elective surgery (FIT-65): a three-day study examining then prevalence of frailty in patients presenting for elective surgery. Perioper Med (Lond). 2022 Aug 25;11(1):42.