The Frailty Factor: A QIP on Recognising Frailty in Acute Hospital Admissions

Introduction

Frailty is a common age-related condition marked by reduced physiological reserve and increased vulnerability to adverse outcomes. National guidance recommends use of the Rockwood Clinical Frailty Scale (CFS) for patients aged ≥65 years during acute hospital admissions to facilitate early recognition of frailty; however, documentation and accuracy remain inconsistent. This quality improvement project aimed to evaluate and improve CFS documentation within inpatient medical wards of a large hospital in London.

Methodology

Two Plan–Do–Study–Act (PDSA) cycles were undertaken using retrospective data collection from a sample size of 299 inpatients aged ≥65 years. Baseline data was collected from 99 patients; 50 General Internal Medicine (GIM) and 49 Geriatric medicine ward patients. We assessed CFS documentation rates and its accuracy based on documented social and functional history. The first intervention consisted of a frailty awareness poster and educational content distributed Trust-wide via email, followed by reassessment of 50 patients from each subgroup. The second intervention involved a targeted teaching session for resident doctors, with a further retrospective review of 100 patients.

Results

Overall, CFS documentation improved from 27% at baseline to 35% and 43% following successive interventions. Subgroup analysis showed substantial improvement of documented CFS especially on geriatric medicine wards (from 35% to 60%). The proportion of patients with undocumented severe frailty (CFS ≥6) decreased from 52% pre-intervention to 30% and 22%, indicating fewer unrecognised advanced frail patients. Accuracy of documented CFS has also improved from 67% at baseline to 71%. Social and functional history documentation remained consistently high (>90%).

Conclusion

This project demonstrates that educational interventions can improve the understanding and recognition of frailty with resulting improved documentation and accuracy of frailty assessments. This in turn supports a timely comprehensive geriatric assessment and optimised care for an increasingly frail and ageing inpatient population.