Using the Self Assessment for Frailty in the Emergency Department Tool (SAFE-T) in urgent and emergency care

Abstract

The Self-Assessment of Frailty in the Emergency Department Tool (SAFE-T), in keeping with the clinical frailly scale (CFS), has been developed as a self-assessment questionnaire. The tool is designed for completion by patients and/or their carers on arrival to urgent care, enabling more efficient and consistent CFS assessment by clinical staff. This is version 3 of the tool, developed via PDSA cycles and co-produced with patients and the MDT.

Method
SAFE-T questionnaires were distributed among a convenience sample of patients over 65 years of age in the ED and acute medicine unit.

Discussions with the MDT explored the tool’s practicality, and a comparative analysis of SAFE-T and MDT frailty scores was conducted.

Results
A total of 52 patients were assessed using both SAFE-T and MDT scoring, one was excluded due to drowsiness.

29.4% (15/51) of patients completed SAFE-T independently, and 70.6% (36/51) required assistance from either family, carers or staff.

The results demonstrated substantial agreement between the two methods, with a Kappa coefficient (r) of 0.69. Minor discrepancies were identified between SAFE-T and MDT assessments, most commonly a 1 point lower SAFE-T score, potentially related to self-assessment subjectivity or timing of scoring. For detection of moderate-severe frailty (CFS 6–7), SAFE-T demonstrated a positive predictive value of 0.81 and a negative predictive value of 0.89.

Conclusion
The substantial agreement between SAFE-T and MDT frailty scores suggests that SAFE-T is a promising tool for frailty assessment. The observed discrepancies underscore the need for further validation in a larger cohort and suggest that SAFE-T’s role as a self-assessment tool may require review. Future revisions could either enhance its usability as a self-assessment or formally integrate it as a healthcare staff-administered tool to maximise its effectiveness in clinical settings.