Improving Comprehensive Geriatric Assessment documentation in Frailty Same Day Emergency Care

Introduction 
Frailty Same Day Emergency Care (SDEC) is an increasingly utilised model supporting admission avoidance while providing an opportunity for multidisciplinary comprehensive geriatric assessment (CGA). One of they key aims of this is to shift focus from the acute hospital setting to the community and to support Neighbourhood Teams by communicating care needs through discharge summaries. 

Methods 
A quality improvement project was undertaken on an acute frailty unit (frailty SDEC). Baseline data were collected for 30 consecutive patients attending the unit over one month. Documentation of CGA domains identified problems, interventions, CGA documentation on discharge summaries, community referrals and one-month readmissions were reviewed. 

We then implemented an updated universal CGA proforma using an Epic “smartphrase” to promote a more structured and comprehensive assessment, alongside clinician education to encourage consistent use. A second cycle reviewed a further 30 consecutive patients following implementation. 

Results 
Thirty patients were included in each cycle. Cycle 1 patients had a mean age of 88 years, 73% were female and median Clinical Frailty Scale (CFS) was 5. Cycle 2 patients had a mean age of 86 years, 60% were female and median CFS was 6. 

CGA completion improved from 90% to 100%. Documentation improved across multiple domains including activities of daily living, medication management, polypharmacy, continence, cognition, mood, nutrition, sensory needs, skin assessment and advance care planning. Bone health remained an area of limited documentation. The question “What matters most?” was rarely used/documented, increasing from 0% to 3.3%. 

Documentation of CGA on discharge summaries improved from 53% to 63%, predominantly for patients discharged directly from the frailty unit, with limited completion for patients discharged from inpatient wards. Community referrals increased from 34.8% to 52.4%, and total one-month readmissions reduced by 30%. 

Conclusion 
A structured CGA proforma and clinician education improved CGA completion and documentation within frailty SDEC. These interventions improved continuity of care into the community and contributed to a reduction in avoidable readmissions. Further work is needed to embed CGA communication across care settings.