Improving the Accuracy of Clinical Frailty Scores in Patients Aged ≥65 Presenting to the Emergency Department

Background: Clinical Frailty Scale (CFS) assessment is a validated tool that supports clinical decision-making, escalation planning and holistic care for older adults. At our Emergency Department, CFS was routinely assigned at triage but was frequently found to be inaccurate when compared with consultant geriatrician assessment, potentially influencing patient management. We aimed to improve the accuracy of CFS documentation by 20% over six months.

Methods: Baseline CFS scores recorded at triage were compared with the reference standard assigned by a consultant geriatrician during the post-take ward round. Median scoring error was measured over 16 post-take ward rounds. A quality improvement project using sequential PDSA cycles was undertaken. The first intervention delivered targeted education to triage staff, including guidance on accurate CFS assessment and promotion of the CFS mobile application. The second intervention utilised CFS documented by Yorkshire Ambulance Service (YAS) paramedics, recognising their greater access to patients' baseline functional status within the home environment.

Results: Training alone produced limited improvement, with staff identifying time pressures and limited collateral information at triage as key barriers to accurate scoring. Following implementation of YAS-derived CFS, median scoring error reduced from 1.00 at baseline to 0.67, representing a 33% improvement. Overall improvement across the project was statistically significant (p=0.029), with the final intervention demonstrating significant improvement compared with baseline (p=0.007).

Conclusions: Process redesign was more effective than education alone in improving CFS accuracy. Incorporating pre-hospital frailty assessments into the emergency care pathway provides a more reliable representation of patients' baseline function and has the potential to support safer, more informed clinical decision-making. Ongoing work focuses on standardising integration of YAS CFS into the electronic patient record to ensure sustainable improvement.