Routine Assessments in Frailty Same Day Emergency Care

Introduction: The documentation proforma used in the Frailty Same Day Emergency Care (FSDEC) unit includes four ‘routine assessments’ to be completed for all patients. These include Rockwood Clinical Frailty Score (CFS), FRAX/QFracture, lying-standing blood pressure and bladder scan. The purpose of our project was to assess how consistently these assessments are completed, and to understand their impact.

Method: We included 100 randomly selected patients referred to FSDEC between August 2025 and April 2026. Data was collected retrospectively from the proforma, including whether assessments were completed and appropriately actioned.

Results: CFS was documented for 98% of patients. 80% had a CFS of 6 or more. 38% were admitted, most of whom (81%) had a CFS of 6 or above. 30 day mortality was 4% (CFS 7-8).

63% of patients had fallen recently. FRAX/QFracture was calculated for 30% of these patients and 37% of all patients. Advanced age, immobility and current bisphosphonate treatment were the most commonly documented reason for FRAX/QFracture not being completed. Of those who had an assessment, 17% received a bisphosphonate or onward referral.

Lying-standing blood pressure was completed for 65%. 43% had a postural blood pressure drop and presence/absence of symptoms was documented for 78%. Interventions for a symptomatic postural blood pressure drop included conservative measures (63%), medication review (25%) and medical management (13%).

82% of patients had a bladder scan. Whether this was pre- or post-void was documented for 48%. 33% of these patients had a high residual volume and 15% had symptoms of acute urinary retention. Attempts to avoid catheterisation were made in 92%, and 23% were catheterised

Conclusion: The FSDEC routine assessments are minimally invasive and time efficient assessments, demonstrated to have a positive impact on patient care. Next steps could aim to use CFS to prompt consideration of advance care planning.