Abstract ID
3849
Abstract category
Abstract sub-category
Abstract
Background:
National and local standards in acute frailty recommend a seven-day service, with front-door assessment and a dedicated frailty area. Many acute frailty teams struggle to maintain a dedicated space as they are vulnerable to becoming inpatient areas when bed pressures increase. The Acute Older Persons Unit (AOPU) at Guys and St Thomas' has faced similar challenges and is based on the Acute Admissions Ward and the Emergency Department. This project assessed whether a dedicated Acute Frailty SDEC (F-SDEC) space increased the number of patients seen and the number of same-day discharges.
Methods:
The AOPU was based in medical SDEC for a trial period of 16 weekends from 23nd February 2025 (F-SDEC). The F-SDEC space has recliner chairs and consultation rooms but no beds or sluice meaning the referral criteria had to change excluding those who required two to transfer or needed a commode. Data was compared between the 3 weeks prior and for 5 weeks following the implementation of F-SDEC.
Results:
The average number of new patients seen per weekend increased from 8 to 14 during F-SDEC. The number of same day discharges increased from 9/24 (37.5% of patients seen) to 33/62 (53.2% of patients seen). The mean clinical frailty score (CFS) decreased from 6.1 to 3.9. The most common presentation was falls (45.3%) pre F-SDEC and falls (20.3%) and infection (20.3%) during F-SDEC.
Conclusions:
F-SDEC increased the number of patients seen and the number of same-day discharges. The average CFS decreased due to the space not being suitable for the most frail. When advocating for space frailty services need to balance ambulatory requirements with the ability to serve the most frail. A dedicated F-SDEC area that accommodates the most frail has the potential to increase same day discharges and improve capacity across the system.
Comments
Impact of a Dedicated Frailty SDEC on Patient Flow and Discharge
This project demonstrates that establishing a dedicated Frailty SDEC significantly increased patient throughput and same-day discharges. However, physical space limitations excluded the most frail individuals, highlighting the need for adaptable frailty areas. Balancing ambulatory capacity with inclusivity is key to optimising patient flow and improving outcomes across acute frailty services.
Thank you for taking the…
Thank you for taking the time to engage with our poster! During the project it became clear we needed to develop a hybrid model whilst we did not have a completely accessible space to ensure the most frail patients did not miss out on the specialist input they deserve.
Really interesting, and cool…
Really interesting, and cool that you got this programme set up. It's easy to imagine how a specific space for frailty patients and frailty-related presenting complaints could better the work-up and care of presenting patients, not least from an efficiency standpoint! Have you managed to continue the project with the dedicated FSDEC space, and if so have you been able to modulate the space/staffing to accommodate the ambulatory/assistance requirements of more frail patients? What were the challenges/learning points with having a direct referral service with the ambulance service? Thank you.
Thank you very much for your…
Thank you very much for your feedback and engaging with our project!
We are still able to use the SDEC space at a weekend for frailty patients but it is also a general medical SDEC space again too so shared. The frailty patients are seen by the frailty consultant and there is a resident doctor also covering frailty. The resident on SDEC also supports if needed and the nursing team support all the patients in the area. The nursing team have been amazing in support for the more frail patients, particularly if needing assistance/supervision to mobilise.
The main issue with the ambulance referrals was having a phone signal for the call! Unfortunately there are areas within the hospital, particularly on the emergency floor, with no phone signal. We were able to overcome this by going via switchboard for the calls or to a handset phone within the unit. It definitely added a lot of value as the patients never needed to attend A&E and come straight to F-SDEC. It was also really helpful to be able to gather information directly from the paramedics with their assessment having been in the patients home.
Great Project and Results
Very interesting project and very promising results! What are the main barriers to sustaining a dedicated F-SDEC space long-term? thank you
Thank you!
I think the main…
Thank you!
I think the main barriers are the spaces being taken over due to the inpatient bed pressures, that inevitably occur in every hospital. We all have experience of the challenges of frail patients being admitted to long stay wards and having prolonged admissions, complicated by de-conditioning and delirium, when if there had been an opportunity to get them home within the initial 24 hour period with the correct community support it could have been avoided. We did not do any health economic analysis but I think this could be the next step and may demonstrate the benefit of persevering these spaces to stakeholders long term, particularly in keeping with the 10 Year Plan!
Sharing space with medical SDEC
Great poster, thank you!
How did you share space with the pre-existing medical SDEC? Did they have space free for you to utilise/were under capacity so you could use this space? Did this mean they saw less patients (as frailty SDEC saw them instead) or was this in addition to the medical SDEC patient numbers? We're looking at something similar in our trust so really helpful work, thank you