Leveraging the Electronic Health Record to Deliver High Fidelity Comprehensive Geriatric Assessment in the Emergency Setting

Introduction

Comprehensive Geriatric Assessment (CGA) in the emergency department can reduce length-of-stay and prevent functional decline in older adults. However, CGA is a complex intervention requiring multi-disciplinary input and appropriate resource investment, making it challenging to deliver for ‘front-door’ frailty services. We hypothesised that improved utilisation of existing functionality within the electronic health record (EHR) could enhance delivery of high fidelity CGA in the emergency setting.

Methods

Quality improvement methodology was employed to evaluate a standardised workflow within the EHR (EPIC SmartPhrase) for assessing and documenting core CGA domains on older adults reviewed by the geriatrician-led acute frailty service at St Thomas’ Hospital in the emergency department/ acute medical unit. Delivery of the components of CGA was assessed before-and-after introduction of this electronic pipeline using 2-sided Fisher’s exact tests.  Statistical analyses performed in SPSS Statistics 31.0.

Results

A post-implementation sample of 59 older adults (median age 85 years, median clinical frailty scale score 6) reviewed in September 2025 was included in our analysis. CGA was performed for all patients with assessment of core domains in the following proportions: physical (n=58/59, 98%), social (n=55/59, 93%), functional (n=54/59, 92%), environmental (n=47/59, 80%), psychological (n=46/59, 78%) and future wishes (n=37/59, 63%). When compared with a retrospective pre-implementation sample of 56 patients reviewed by the frailty service in June 2024, significant improvements in the assessment and documentation of polypharmacy (+88%, p<0.001), bone health (+63%, p<0.001), nutritional status (+35%, p<0.001), sensory issues (+35%, p<0.001) and advance care planning (+27%, p=0.005) were observed. Notably, 33% of patients (n=19/59) reviewed in our post-implementation cohort who had been referred for hospital admission were discharged on the day of assessment.

Conclusion

Resident doctor-led implementation of a comprehensive EHR workflow improves the fidelity of CGA for older adults in the emergency setting, promoting same-day discharge in one third of patients.