The impact of acute frailty SDEC in improving same day discharge and patient flow

Introduction:
In April 2025, Darlington Memorial Hospital introduced a same-day Frailty Assessment Unit (FAU) and Hospital at Home (H@H) virtual ward service, both staffed seven days a week by senior clinicians and advanced therapists. These services aimed to provide earlier comprehensive geriatric assessment, facilitate admission avoidance, and support more older adults to receive care in the community. This work built on best practice from other trusts nationally, and aims to forward the agendas of the NHS 10-year Health Plan for England and Getting It Right First Time to move care from hospital to the community. 

Methods:
We prospectively analysed routinely collected data for all patients assessed by the frailty team. Recorded variables included age, Rockwood Clinical Frailty Scale (CFS), NEWS, 4AT, assessment location and outcome. Outcomes from October 2024–March 2025, whilst working in a liaison model before implementation of the FAU and H@H services, were compared with October 2025–March 2026, when both services were fully established.

Results:
A total of 2232 patients were assessed in the first period and 2263 in the second. Patient characteristics were similar between cohorts (mean age 83.3 vs 83.8 years; CFS 5.5 vs 5.3; NEWS 1.7 vs 1.3; 4AT 3.7 vs 3.0). In the second period, 42% of patients were assessed in our new FAU. Same-day discharges increased from 478 (21.4%) to 899 (39.7%), while admissions to acute medical beds fell from 64.3% to 48.6%. Readmission rates did not increase.

Conclusions:
Introduction of the FAU and H@H services enabled substantially more older adults with similar levels of frailty and illness severity to be managed in the community, increasing same-day discharge and reducing acute medical admissions without increasing readmissions. These findings support integrated frailty services as an effective model for improving patient flow while delivering care closer to home.