Proactive Comprehensive Geriatric Assessment for Older Adults Living with Frailty on Surgical Wards: A QI Test of Change

Introduction: Older adults living with frailty admitted to surgical wards have complex multidisciplinary needs and experience poorer outcomes than patients without frailty. Although well evidenced, access to comprehensive geriatric assessment (CGA) within our tertiary surgical centre is limited, with only 21% of inpatients with frailty receiving CGA. We evaluated the impact of introducing proactive CGA during a one-week quality improvement test of change.

Methods: A proactive frailty service was implemented on general surgical wards at the Queen Elizabeth University Hospital, Glasgow. Interventions included daily frailty screening of patients aged ≥75 years, daily geriatrician and Elderly Care Assessment Nurse reviews, and multidisciplinary team huddles with allied health professionals. Outcomes were compared with baseline audit data and included CGA delivery, time to assessment, interventions performed, length of stay, readmissions and staff feedback.

Results: During the intervention week, 44 patients were aged ≥75 years, of whom 33 (75%) were frail. CGA delivery increased from 20.8% at baseline to 100% of frail patients. Median time to CGA decreased from 7.5 to 1 day for newly admitted patients living with frailty. CGA identified multiple unmet needs including delirium, falls, polypharmacy, medical optimisation, rehabilitation planning and discharge planning. Median length of stay reduced from 15 to 11 days, while median length of stay among patients discharged alive reduced from 13 to 10 days. Thirty-day readmissions decreased from 30% to 21%. Staff feedback was universally positive, highlighting improved multidisciplinary communication, earlier rehabilitation planning and more holistic patient care.

Conclusions: Proactive delivery of CGA for surgical inpatients with frailty substantially improved access to specialist geriatric assessment, reduced delays to review and was associated with shorter hospital stay and lower readmission rates. These findings support expansion of proactive perioperative frailty services and wider implementation of CGA across surgical specialties.