The implementation of a Cardiogeriatrics Liaison Service at a District General Hospital: a Quality Improvement Project

Introduction 

The involvement of geriatricians in the care of frail, older patients under other specialities, particularly within perioperative settings, has shown to improve outcomes (1). There is growing support for using Comprehensive Geriatric Assessments (CGAs) within Cardiology, due to the prevalence of cardiovascular disease within this cohort and the challenges frailty presents to clinical decision-making (2,3).  

Methods 

Our aim was to increase the percentage of CGAs carried out for patients admitted under Cardiology aged ≥65 with a Clinical Frailty Score (CFS) of ≥5 by 50%, between November 2025 and April 2026. Driver diagrams highlighted the need to establish a referral pathway, provide education to the Cardiology department and improve clarity of communication between teams. This resulted in piloting a Geriatrician-led inpatient consult-type service (Cardiogeriatrics Liaison Service). Multiple interventions implemented via PDSA cycles included teaching sessions, advertising posters and developing a documentation proforma.  

Results 

The number of CGAs completed increased from 0% pre-intervention, to 83% in cycle 1 and 75% in cycle 2.  Secondary outcome measures also showed positive progress. CFS documentation by cardiology increased from 0% to 33%, with CFS now incorporated into their ward round proforma. Medication de-prescribing increased significantly; 73% of patients had one or more non-cardiac medication deprescribed in cycle 1 and 50% in cycle 2, saving a total of £914.58 in ongoing prescription charges. Opportunistic bone health assessment led to patients deemed appropriate for further investigation or treatment increasing to 33% in cycle 1 and 42% in cycle 2.  

Conclusion  

We achieved our aim of increasing CGAs in this patient cohort, which improved patient care in assessing frailty-specific issues, such as polypharmacy and bone health. This project has served to emphasise the importance of frailty to another medical speciality, increased their understanding of frailty syndromes and ultimately fostered a positive working relationship between the two specialities.